Objective: Test the hypothesis that alcoholism, including antisocial alcoholism, is more prevalent among mothers and fathers of children with versus without ADHD. Method: Mothers (312 ADHD group, 235 non-ADHD group) and fathers (291 ADHD group, 227 non-ADHD group) in the Pittsburgh ADHD Longitudinal Study were interviewed along with their adolescent and young adult offspring. Results: Maternal and paternal alcoholism, with and without comorbid antisociality, was more prevalent in the ADHD group. Paternal alcoholism without antisociality was only marginally higher for probands after controlling for paternal ADHD. Offspring conduct disorder comorbidity was associated with parental antisociality but not parental antisocial alcoholism. Conclusion: Our findings that 44% of proband fathers and 25% of proband mothers experienced alcohol problems with or without antisociality are further evidence of increased alcoholism prevalence in families affected by ADHD. Maternal alcoholism and antisociality are prominent contributors to this family-level vulnerability. These findings indicate the need to assess long-term offspring outcomes as a function of parental alcohol and externalizing comorbidities, and perhaps other indicators of parental alcoholism phenotype, as familial vulnerability unfolds across development.
Objective: This study evaluated whether sluggish cognitive tempo (SCT) is separable from ADHD–inattention (IN) and uniquely associated with internalizing dimensions in preschool children in South Korea. Method: Mothers of 172 preschool children (ages 4-6 years; 52% girls) rated children’s SCT, ADHD-IN, ADHD–hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), aggression, emotional reactivity, anxiety/depression, somatic complaints, withdrawal, and sleep problems. Results: Eight of 10 SCT symptoms showed convergent and discriminant validity with ADHD-IN. ADHD-IN remained significantly positively associated with ADHD-HI, ODD, and aggressive behavior after controlling for SCT, whereas SCT was no longer positively associated with these externalizing behaviors after controlling for ADHD-IN. Both SCT and ADHD-IN were uniquely associated with greater emotionally reactivity, anxiety/depression, and withdrawal. Only SCT was uniquely associated with somatic complaints, and only ADHD-IN was uniquely associated with sleep problems. Conclusion: Findings replicate results with children and adolescents, thus expanding evidence for the validity of SCT in early development.
Objective: There is a lack of evidence-based diagnostic paradigms and personalized interventions for preschoolers with ADHD. This study aimed to evaluate the performance of preschoolers diagnosed with ADHD on a continuous performance test (CPT) before and after a single methylphenidate (MPH) challenge. Method: The Test of Variables of Attention (TOVA)—a CPT—was administered to 61 preschoolers (5.64 ± 0.69 years; 74% boys) with ADHD before and after a single MPH challenge (0.3 or 0.5 mg/kg). Baseline TOVA performance was correlated with Conners’ Rating Scales (CRS) and compared with post-MPH TOVA performance. Results: A high rate of omission errors and several significant correlations between TOVA values and CRS scores were found at baseline. A single MPH administration improved TOVA performance significantly and was well tolerated. Conclusion: TOVA assessment may assist in the evaluation of the effect of MPH in preschoolers with ADHD and may help in planning interventions for them.
Objective: To explore personality and readiness to change among substance use disorders (SUD) patients with and without ADHD. Method: SUD + ADHD versus SUD – ADHD patients consecutively entering treatment between 2010 and 2012 were compared concerning personality (Temperament and Character Inventory) and readiness to change (Stages of Change Readiness and Treatment Eagerness Scale). Results: Among 103 SUD patients (76 men, age M = 43.3, SD = 11.1), 16 (15.5%) were diagnosed with ADHD. SUD + ADHD patients reported significantly elevated eagerness to effort (p = .008) compared with SUD – ADHD patients, who reported significantly elevated fear of uncertainty (p < .000). SUD + ADHD patients reported higher ambition (p = .025), self-forgetfulness (p = .029), and lower recognition (p = .022). They were younger (p = .019) and showed more often amphetamine addiction (p = .022) compared with SUD – ADHD patients. Conclusion: The distinct characteristics found in SUD + ADHD and SUD – ADHD patients underline the need for differentiated treatment interventions.
Objective: We assessed the correlation between the deficits of cognition, movement, and brain activity in children with Attention Deficit Hyperactvity Disorder (ADHD). Method: We recruited 15 children with ADHD and 15 age- and sex-matched healthy control participants. Clinical symptoms, cognitive shifting, movement shifting, and brain activity were assessed using the Korean ADHD Rating Scale, the Wisconsin Card Sorting Test (WCST), the 7- and 14-ring drill test with hop jumps (7 HJ and 14 HJ), and 3.0 Tesla functional magnetic resonance imaging scanner, respectively. Results: ADHD children showed an increased distance traveled and decreased speed on the 14 HJ task. In response to the WCST task, ADHD children showed decreased activation within right gyrus. Total distance on the 14 HJ task was negatively correlated with the mean β value of Cluster 2 in ADHD children. Conclusion: These results suggested that children with ADHD showed difficulty with attention shifting as well as with movement shifting.
Objective: This study examined ADHD comorbidity in child and adolescent patients who diagnosed with posttraumatic stress disorder (PTSD) or obsessive compulsive disorder (OCD). Method: Sixty-eight child and adolescent patients with PTSD and 42 child and adolescent patients with OCD were evaluated for ADHD. The sample included 110 patients who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Results: Results showed that 22.05% patients with PTSD and 59.52% patients with OCD met criteria for ADHD. Conclusion: The results of our study indicate that no meaningful differences were detected in comparisons between PTSD and OCD groups, in having ADHD as comorbidity.
Objective: This research aimed to examine the impact of attention deficit disorder (ADD)/ADHD in children on parental labor force participation across different child age groups. Method: This study utilized a longitudinal, quantitative analyses approach. All data were collected from Wave 6 of the Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) survey. Results: After adjusting for various confounders, mothers whose children were 10/11 years old and had been diagnosed with ADD/ADHD were significantly more likely to be out of the labor force compared with those mothers whose child had not been diagnosed with ADD/ADHD. The impact was more pronounced for single mothers. No significant influence on paternal labor force participation was found. Conclusion: In assessing the cost-effectiveness of interventions for ADD/ADHD, policy makers and researchers must consider the long-term social and economic effects of ADD/ADHD on maternal workforce participation when considering costs and outcomes.
Objective: The aim of the study was to evaluate associations between ADHD and comorbid psychiatric disorders among adults from a population-based birth cohort. Method: Participants were recruited from all children born between 1976 and 1982 remaining in Rochester, Minnesota, after age 5. Participants with childhood ADHD (n = 232; M age = 27.0 years; 72% men) and non-ADHD controls (n = 335; M age = 28.6 years; 63% men) completed a structured interview (M.I.N.I. International Neuropsychiatric Interview) assessing current ADHD status and comorbid psychiatric disorders. Results: Among 232 with childhood ADHD, 68 (49 men, 19 women) had persistent adult ADHD. Compared with non-ADHD controls and non-persistent ADHD participants, adults with persistent ADHD were significantly more likely to have any or each of 12 psychiatric comorbidities. The associations retained significant or marginally significant when stratified by gender. Externalizing psychiatric disorders were more common in men (74%) and internalizing disorders in women (58%). Conclusion: Persistent ADHD is associated with an increased risk of comorbid psychiatric disorders in adult men and women.
Objective: Stimulants are safe and effective medications for the treatment of ADHD. There are a number of case studies that report stimulant-induced dyskinesia. The aim of this study was to compare dyskinesia in a treated and a treatment-naive group of children with ADHD, and a healthy control group. Method: Children aged 6 to 18 years were involved in the study (n = 158). Diagnosis of ADHD was measured with the Mini International Neuropsychiatric Interview Kid (MINI Kid). Dyskinesia was assessed with the Abnormal Involuntary Movement Scale (AIMS). Results: Before methylphenidate administration, the treated ADHD group showed significantly higher AIMS total score than the control group (p = .001) and the treatment-naive ADHD group (p < .001). We found the same pattern 1.5 hr after methylphenidate administration. Conclusion: These results call attention that clinicians should take special care for the possible development of dyskinesia during the treatment of their ADHD patients with methylphenidate.
Objective: Continuous Performance Tests (CPTs) are known to measure inattention and impulsivity in students with ADHD. Many CPTs utilize a visual format. It is accepted that auditory tasks reflect attentional demand more closely in the classroom. Thus, the association between deficits found by auditory and visual CPTs needs to be studied. We hypothesized that impulsivity would be dependent on sensory modality and inattention would be a unitary cross-modal construct. Method: Forty-four students with ADHD performed two CPTs (visual and auditory). We analyzed correlations between the variables examined by the two tasks. Results: There were strong correlations between variables measuring inattention. Correlations between auditory and visual measures of impulsivity were weak. Conclusion: Inattention is partially independent of modality. In contrast, response inhibition is modality-specific. Although ADHD is defined regardless of modality, hyperactive students may exhibit deficits in the auditory modality but not in the visual modality or vice versa.
Objective: The aim of the study was to assess the relationship of overweight, the polymorphisms of selected candidate genes, and deficits in the executive functions among children with ADHD. Method: We examined 109 boys with ADHD aged between 7 and 17 years. The study indicated variants of 14 polymorphisms in eight candidate genes. We applied seven neuropsychological tests to evaluate the executive functions. Overweight was diagnosed on the basis of the guidelines of the International Obesity Task Force. Results: Analyses revealed significant association between DRD4 rs1800955, SNAP25 rs363039 and rs363043, 5HTR2A rs17288723, and overweight in boys with ADHD. There were no significant differences in the level of neuropsychological test results between patients with overweight and without overweight. Conclusion: Overweight in boys with ADHD is associated with polymorphisms in three candidate genes: DRD4, SNAP25, and 5HTR2A, but not through conditioning deficits in cognitive functions.
Objective: To validate an electronic health record (EHR)–based algorithm to classify ADHD status of pediatric patients. Method: As part of an applied study, we identified all primary care patients of The Children’s Hospital of Philadelphia [CHOP] health care network who were born 1987-1995 and residents of New Jersey. Patients were classified with ADHD if their EHR indicated an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "314.x" at a clinical visit or on a list of known conditions. We manually reviewed EHRs for ADHD patients (n = 2,030) and a random weighted sample of non-ADHD patients (n = 807 of 13,579) to confirm the presence or absence of ADHD. Results: Depending on assumptions for inconclusive cases, sensitivity ranged from 0.96 to 0.97 (95% confidence interval [CI] = [0.95, 0.97]), specificity from 0.98 to 0.99 [0.97, 0.99], and positive predictive value from 0.83 to 0.98 [0.81, 0.99]. Conclusion: EHR-based diagnostic codes can accurately classify ADHD status among pediatric patients and can be used by large-scale epidemiologic and clinical studies with high sensitivity and specificity.
Objective: The aim of this study is to assess the onset and duration of efficacy of multilayer-release methylphenidate (PRC-063) over 16 hr compared with placebo in adults with ADHD using the simulated adult workplace environment. Method: After dose-optimization with PRC-063, participants entered a double-blind, placebo-controlled, crossover phase. Primary outcome measure was the Permanent Product Measure of Performance (PERMP) total score measured pre-dose and from 1 to 16 hr post-dose. Results: Of the 59 randomized participants, 45 participants completed the study. While receiving PRC-063, adults had greater improvement from pre-dose in mean PERMP total scores across all time points compared with placebo (51.5 ± 29.22 vs. 23.9 ± 31.27; p < .0001). Common adverse events were decreased appetite, headache, and insomnia. There was no significant impact on overall sleep quality (p = .9542). Conclusion: PRC-063 significantly improved PERMP scores with an onset within 1 hr post-dose, and maintained improvement throughout the 16 hr post-dose study period compared with placebo in adults with ADHD.
Objective: Although the prevalence of adult ADHD has been well established in the general population, few studies have examined the prevalence of ADHD symptoms in the military. Method: The present study used data from 21,449 active duty soldiers, whose responses were collected as part of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Positive ADHD screens were identified using two alternative scoring methods of the Adult Self-Report ADHD Scale Screener. Results: The estimated prevalence of ADHD in this sample was 7.6% and 9.0% depending on diagnostic method. Contrary to initial hypotheses that ADHD would be highest in the 18- to 19-year-old age-group, the age distribution of ADHD in this study was centered around the 25- to 29-year-old age-group. Conclusions: The findings of this study indicate that adult ADHD symptoms are common in Army personnel, and are not limited to the youngest cohorts. Implications on screening, administrative policy, and future research directions are also discussed.
Objective: Recent trials have demonstrated efficacy of cognitive behavioral therapy (CBT) in medicated adults with ADHD. Efficacy of CBT in unmedicated versus medicated adults remains mostly unknown. We evaluated the effects of group CBT alone versus combined with medication on ADHD symptoms and functional outcomes in adult patients. Method: Eighty-eight adults with ADHD received 12 manualized group CBT sessions, accompanied by individual coaching, either without (n = 46) or with (n = 42) medication. Treatment effects were evaluated following treatment and 3-month and 6-month follow-up using un-blinded self-report and observer ratings. Results: CBT + medication resulted in greater improvements than CBT alone in ADHD symptoms, organizational skills, and self-esteem. Group differences diminished over follow-up, as the CBT alone group continued improving, while the combined group maintained the gains. Conclusion: CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.
Objective: To systematically review, synthesize, and appraise available evidence, connecting adult ADHD (aADHD) with somatic disease. Method: Embase, Psychinfo, and Medline databases were searched for studies published from 1994 to 2015 addressing aADHD and somatic comorbidity. Somatic conditions were classified according to International Classification of Diseases (ICD-10) codes. Levels of evidence were graded as inconclusive, tentative, or well documented. Results: Most of the 126 studies included in the qualitative synthesis were small and of modest quality. Obesity, sleep disorders, and asthma were well-documented comorbidities in aADHD. Tentative evidence was found for an association between aADHD and migraine and celiac disease. In a large health registry study, cardiovascular disease was not associated with aADHD. Conclusion: There are few large systematic studies using standardized diagnostic criteria evaluating aADHD and somatic comorbidities. Significant associations are found between aADHD and several somatic diseases, and these are important to consider when assessing and treating either aADHD or the somatic diseases.
Objective: To assess the features of sleep in preschoolers with ADHD by means of questionnaire and actigraphy. Method: Twenty-five ADHD and 21 age-matched typically developing (TD) preschool children underwent the Child Behavior Checklist (CBCL) for ages 11/2 to 5 and Pre-School-Age Psychiatric Assessment interview. Sleep was assessed by means of a modified Sleep Disturbance Scale for Children and wrist actigraphy for at least 5 days. Results: Children with ADHD, compared with TD, showed higher scores in CBCL Withdrawal (58.83 vs. 51.15, p < .0001), Attention Problems (69.88 vs. 51.54, p < .0001), and Aggressive Behavior (59.46 vs. 51.08, p < .0001) dimensions; they also showed increased actigraphic nocturnal activity (activity index 31.57 vs. 25.74, p < .05); and night-to-night variability for sleep minutes (56.44 vs. 32.79, p < .01), mean wake episodes (1.34 vs. 0.98, p < .05), mean activity (2.64 vs. 1.71, p < .05), and activity index (5.15 vs. 3.77, p < .05). Conclusion: This pilot study in preschoolers with ADHD showed increased motor activity during sleep and night-to-night variability for sleep duration and motor activity.
Objective: This study examined whether college students who reported higher levels of sluggish cognitive tempo (SCT) symptoms were actually more "sluggish" in their performance while completing speeded cognitive and academic measures. Method: College students (N = 253) completed self-reports of SCT and their reading and test-taking abilities as well as tests of processing speed, reading fluency, and reading comprehension. Results: Across all variables, SCT symptoms were most significantly associated with self-reported difficulty on timed reading tasks. However, students with high SCT scores were not significantly slower than controls on any of the timed tasks. Conclusion: In college students, self-reports of high SCT levels do not suggest actual slow performance on cognitive and academic tasks.
Objective: To investigate the clinical implications of obsessive-compulsive disorder (OCD) and ADHD comorbidity in adults. Method: The OCD patients who had and had no diagnosis of adulthood ADHD were compared in terms of several demographic and clinical variables. Results: The mean number of obsessions and compulsions; hoarding, symmetry, and miscellaneous obsessions; ordering/arranging and hoarding compulsions; total, attentional, and motor subscale scores of Barratt Impulsivity Scale (BIS)-11 were more frequent among the patients with OCD-ADHD. The mean age of onset was more likely to be earlier in ADHD-OCD group than in OCD group. Impulsivity, symmetry obsessions, and hoarding compulsions strongly predicted the coexistence between ADHD and OCD. Conclusion: OCD-ADHD comorbidity in adults seemed to be associated with an earlier onset of OCD, with the predominance of impulsivity, and with a different obsessive-compulsive symptom (OC) profile from OCD patients without a diagnosis of ADHD.
Objective: We tested mediation of birth weight and ADHD symptoms by multiple biologically plausible neurocognitive functions and evaluated familiality of observed indirect effects. Method: 647 youth from 284 multiplex families with ADHD completed the Arithmetic, Digit Span, Vocabulary, and Block Design subtests of the Wechsler Intelligence Scale for Children (WISC). Multiple mediation tested WISC subtests as mediators of birth weight and multi-informant ADHD symptoms. Familiality of indirect effects was estimated via moderated mediation comparing conditional indirect effects across siblings concordant and discordant for ADHD. Results: Controlling for IQ and demographic factors, Arithmetic uniquely mediated birth weight and ADHD symptoms. Conditional indirect effects through Arithmetic did not differ across ADHD concordant and discordant siblings. Conclusion: These cross-sectional findings support previous prospective longitudinal research implicating Arithmetic (i.e., fluid reasoning) as a preliminary causal mediator of birth weight and ADHD symptoms, and suggest that this pathway is independent of genetic influences on ADHD.
Objective: Our aim is to investigate the impact of childhood ADHD comorbidity on the clinical features of obsessive compulsive disorder (OCD). Method: Ninety-five adult outpatients with a diagnosis of OCD were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version, ADHD module, and the Yale–Brown Obsessive Compulsive Scale. Patients with or without childhood ADHD were compared in terms of the sociodemographic and clinical features, psychiatric comorbidities, and rating scales. Results: The rate of episodic course of OCD (p < .001), religious and sexual obsessions (p = .009, p = .020, respectively), lifetime comorbidity of bipolar disorder (BD), social anxiety disorder (SAD; p = .001, p = .009, respectively), and tic disorder (TD) comorbidity (p < .001) were higher in the OCD + ADHD group than in the OCD without ADHD group. Conclusion: Childhood ADHD may be associated with higher rates of BD, SAD, and TD comorbidity and episodic course of OCD as well as higher frequency of certain types of obsessions.
Objective: Previous research has shown that parent attributions for child behavior have important implications on the parent–child relationship. The current study investigates whether mothers’ level of ADHD symptoms is associated with their child-responsibility attributions for positive and negative child behavior. Method: Seventy-nine mothers of 6- to 11-year-old boys participated in this online study. Mothers completed questionnaires assessing their attributions, their ADHD symptoms, and their child’s behavior. Results: All mothers offered more child-responsibility attributions for positive behaviors than for negative behaviors. However, mothers with greater levels of ADHD symptoms did this to a lesser extent, blaming their child relatively more for negative behavior and giving their child relatively less credit for positive behavior. Conclusion: This is the first study demonstrating the association between mothers’ ADHD symptoms and child-responsibility attributions. It is possible that these relatively more negative attributions could be underlying some of the parenting difficulties reported by parents with ADHD.
Objective: The purpose of the present study was to examine the prevalence of celiac disease (CD) in children and adolescents with ADHD. Method: In all, 102 participants between 4 and 18 years of age diagnosed with ADHD participated in the study (M = 12.8 years; 84 boys and 18 girls). CD was diagnosed according to the adapted guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPHGAN). Results: Among 102 tested children and teenagers with ADHD, we did not find anyone with suspected CD, so further diagnostic procedures for CD were not indicated. Conclusion: In our sample of children and teenagers with ADHD, the prevalence of CD was not higher than in the general population. On the basis of the obtained results and the results of similar studies, we conclude that there are not enough data to support screening for CD and the introduction of a gluten-free diet in children with ADHD unless there are additional indications.
Objective: To examine the efficacy of a Cognitive-Functional (Cog-Fun) intervention for children with ADHD. Method: Random allocation of 107 children to study or control groups preceded 10 parent–child weekly Cog-Fun sessions emphasizing executive strategy training in games and daily activities. Controls received treatment after crossover. Study participants were followed up 3 months post-treatment. Outcomes included parent/teacher ratings of executive functions, ADHD symptoms, and parent ratings of quality of life. Results: Eight children withdrew prior to treatment. All children in both groups who began treatment completed it. Mixed effects ANOVA revealed significant Time x Group interaction effects on all parent-reported outcomes. Treatment effects were moderate to large, replicated after crossover in the control group and not moderated by medication. Parent-reported treatment gains in the study group were maintained at follow-up. No significant Time x Group interaction effects were found on teacher outcomes. Conclusion: Cog-Fun occupational therapy (OT) intervention shows positive context-specific effects on parent, but not teacher, ratings.
Objective: This study examined the association between autism spectrum disorder (ASD) symptom severity and academic outcomes and classroom functioning in a community-based sample of children with and without ADHD. Method: Participants included children with ADHD (n =179) and a non-ADHD group (n =212). ASD symptom severity, academic and learning skills, and classroom functioning were assessed via teacher report using the Social Skills Improvement System (SSIS; ASD and Academic Competence subscales) and the Strengths and Difficulties Questionnaire (SDQ; all subscales). Results: Children with ADHD had higher teacher-reported ASD symptoms than children without ADHD (β= .62, p< .001). Greater teacher-reported ASD symptoms were associated with more behavioral difficulties in the classroom for children with ADHD (β= .50, p< .001). There was little evidence of an association between academic competence and ASD symptom severity in children with ADHD (β= –.11, p = .15). Conclusion: ASD symptoms are associated with elevated classroom behavioral difficulties for children with ADHD.
Objective: This randomized control trial evaluated the efficacy of an online self-help program in a sample of parents of preschoolers with ADHD symptoms. Method: Parents were randomly assigned to the intervention group (n = 27) or the delayed intervention group (n = 26). Child behavior measures were completed by mothers, fathers, and teachers, and parenting measures were completed by mothers. Results: Intent-to-treat analyses indicated significant post-intervention improvements in mother-rated child hyperactivity/inattention, restlessness/impulsivity, defiance/aggression, social functioning, and teacher-rated prosocial behavior, as well as significant improvements in maternal over-reactivity, verbosity, laxness, positive parenting, parenting satisfaction, self-efficacy, stress, and depression. At 6-month follow-up, effects were maintained for maternal over-reactivity and verbosity, parenting satisfaction and self-efficacy, and parental stress and depression. Conclusion: This study provides evidence for the effectiveness of an online self-help parenting program in reducing preschool inattentive behavior difficulties, and in increasing parenting competence, satisfaction in the parenting role, and maternal well-being.
Objective: We assessed factors influencing quality of life (QoL) in adults with ADHD. Method: QoL, traumatic childhood experiences, and depression were assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Childhood Trauma Questionnaire (CTQ), and Beck Depression Inventory (BDI), respectively, in 60 adult ADHD outpatients and 60 age- and gender-matched controls. Results: Emotional neglect or abuse had occurred significantly more often during childhood in adults with ADHD. Depressive symptoms were rated significantly higher by ADHD patients. QoL was significantly lower in adults with ADHD, and the variables depression, ADHD symptom severity, and traumatic load, accounted for ~60% of variance in overall QoL. Conclusion: QoL is significantly reduced in adult ADHD patients. Depressive symptoms and traumatic childhood experiences influence QoL. Treatment for adult ADHD patients should take the high interdependence of depressive symptoms, childhood trauma, and QoL into consideration.
Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive–impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.
Objective: Past research has provided some preliminary evidence that ADHD and reactive aggression have overlapping neurocognitive bases. Based on this, we tested the hypothesis that ADHD symptoms are closely coupled in developmental terms with reactive aggression, more so than with proactive aggression with which it has been postulated to be only indirectly linked. Method: We used latent growth curve analysis to estimate the developmental relations between ADHD symptoms and subtypes of aggressive behavior in a normative sample of 1,571 youth (761 female, 810 male) measured from ages 7 to 15. Results: Individual ADHD trajectories were significantly and substantially correlated with individual trajectories in both aggressive subtypes; however, consistent with our hypothesis, the relation with reactive aggression was significantly stronger. Conclusion: Our study provides some of the first evidence for a differential relation between ADHD symptoms and aggression subtypes not only cross-sectionally but also in terms of their longitudinal developmental trajectories.
Objective: The hypothesis behind this study was that trained teachers using cooperative learning procedures with children in their classroom (aged from 6 to 10 years) can influence the social skills of children with ADHD symptoms and their acceptance by their peers. Method: The study involved 30 children with ADHD symptoms attending 12 different classes, where cooperative learning was adopted in some, and standard practices in others. ADHD children’s symptoms, social skills, and cooperative behavior were assessed by means of a teacher’s questionnaire, and the social preferences of the children in their class were collected. Results: Changes emerged in teachers’ assessments of the children’s cooperative behavior in the experimental classes. Improvements in the sociometric status of children with ADHD symptoms were only seen in the cooperative learning classes. Conclusion: These results show the importance of well-structured intervention in classes that include children with ADHD symptoms. Implications of these findings for future intervention are discussed.
Objective: The objective was to examine the frequency of comorbid disorders in children and adolescents with ADHD in Turkey and to evaluate the distribution of comorbidities according to the subtypes of ADHD and sociodemographic features. Method: The sample consisted of 1,000 children, 6 to 18 years of age, including 242 females and 758 males, from Ege University who were diagnosed with ADHD. Results: The overall prevalence rate of psychiatric comorbidity in the study was 56.3%. The most frequently observed comorbidity was oppositional defiant disorder with a rate of 37.4%. Conduct disorder, depressive disorder, obsessive-compulsive disorder, and anxiety disorder accompanied ADHD, respectively. The results revealed that 70.2% of the children with ADHD-Combine type had at least one psychiatric comorbidity. Oppositional defiant disorder, conduct disorder, depressive disorder, and obsessive-compulsive disorder accompanied ADHD-Combine type in 54.6%, 12.6%, 8.1%, and 8.8% of the participants, respectively. Conclusion: These findings provide valuable information about the comorbid disorders in children and adolescents with a very large clinical sample of ADHD children.
Objective: This study was conducted to investigate the association between changes in ADHD symptoms, executive functions (EFs), and depression symptoms in girls and boys with ADHD over a 2-year period. Method: Thirty-six girls and 39 boys with ADHD, 18 typically developing (TD) girls and 29 TD boys (ages 9-16) were included. Assessments of EFs, ADHD symptoms, and self- and parent-report of depression symptoms were carried out. Results: For girls, a reduction of inattention symptoms was associated with a decline in parent-rated depression symptoms. A reduction in hyperactivity/impulsivity was associated with a reduction in self-rated depression symptoms in boys, and an increase in girls. A reduction in inattention symptoms was associated with a modest increase in self-rated depression symptoms in both boys and girls. Conclusion: Gathering information from both the parents and the child with ADHD is important in determining how gender may be influencing symptom profiles.
Objective: This study examined differences between children with ADHD and comorbid depression (n = 26), ADHD only (n = 111), and a community control group (n = 130) on measures of family and maternal characteristics. Method: The present study utilized a large, community sample. Diagnoses required positive endorsements from multiple sources. ANOVAs and chi-square tests were conducted to determine group differences. Results: Compared with children with ADHD alone and community controls, mothers of depressed ADHD children reported decreased family cohesion, limited participation in social/recreational activities, increased maternal depressive symptoms, difficulty coping with parenting roles, and higher rates of bipolar and anxiety disorders. Mothers of children with ADHD (with or without comorbid depression) reported increased conflict, decreased cohesion, and poor maternal coping compared with community controls. Conclusion: Findings are consistent with prior literature suggesting that families of children with ADHD and depression demonstrate both similar and unique characteristics. Clinical implications are discussed.
Objective: Symptoms of sluggish cognitive tempo (SCT) have been considered a potential subset of symptoms of ADHD, predominantly inattentive presentation (ADHD-I), or as a separate but related symptom dimension. We sought to characterize the relationships between SCT and both internalizing symptoms and executive functioning in adults with ADHD. Method: One hundred two adults diagnosed with ADHD completed clinical interviews and clinical rating scales. Hierarchical regression analyses were conducted to ascertain the independent predictive power of SCT symptoms for executive dysfunction after considering ADHD inattentive and hyperactive-impulsive symptoms and internalizing symptoms. Results: SCT was correlated with ADHD inattentive symptoms and dimensional measures of depression and anxiety symptoms, but not with clinical diagnosis of depression or anxiety disorder. SCT was independently predictive of executive function deficits over and above the effects of internalizing and ADHD symptoms. Conclusion: SCT in adults is associated with internalizing symptoms, ADHD inattentive symptoms, and, independently, with executive function deficits, particularly organization and problem solving.
Objective: The purpose of this study is to provide reliability and validity evidence of the Adult Self-Report Scale (ASRS) scores on different versions and scoring procedures in a Spanish substance use disorder (SUD) sample. Method: The sample was made up of 170 outpatients diagnosed with SUD. The ASRS, the Mini-International Neuropsychiatric Interview (MINI), and the Substance Dependence Severity Scale were administered. Results: The results of the confirmatory factor analysis (CFA) showed adequate fit to the structure proposed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) in the 18-item version. On the screening scale, best fit was found for a model with two correlated factors (inattention and hyperactivity). The exploratory factor analysis (EFA) showed that the ADHD items converge and are differentiated from symptoms of withdrawal. The regression analyses showed that severity of dependence is explained by the ASRS scores. Conclusion: Both versions of the ASRS showed adequate psychometric properties. The polytomous or dichotomous score is relevant in patient classification.
Objective: Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disruptive mood dysregulation disorder (DMDD) is a controversial new diagnosis. No studies have investigated DMDD symptoms (irritable-angry mood and temper outbursts) and demographics in general population and psychiatric samples. Method: Maternal ratings of DMDD symptoms and diagnoses, age, gender, IQ, race, and parent occupation were analyzed in general population (n = 665, 6-12 years) and psychiatric samples (n = 2,256, 2-16 years). Results: Percentage of school-age children with DMDD symptoms were 9% general population, 12% ADHD-I, 39% ADHD-C, and 43% autism. Male, nonprofessional parent, and autism with IQ > 80 were associated with increasing DMDD symptoms, but demographics together explained only 2% to 3% of the DMDD score variance. Conclusion: Demographics contributed little to the presence of DMDD symptoms in all groups, whereas oppositional defiant disorder (ODD) explained most of the variance. Almost all children with DMDD symptoms had ODD suggesting that DMDD may not be distinct from ODD.
Objective: ADHD consists of a count of symptoms that often presents heterogeneity due to overdispersion and excess of zeros. Statistical inference is usually based on a dichotomous outcome that is underpowered. The main goal of this study was to determine a suited probability distribution to analyze ADHD symptoms in Imaging Genetic studies. Method: We used two independent population samples of children to evaluate the consistency of the standard probability distributions based on count data for describing ADHD symptoms. Results: We showed that the zero-inflated negative binomial (ZINB) distribution provided the best power for modeling ADHD symptoms. ZINB reveals a genetic variant, rs273342 (Microtubule-Associated Protein [MAPRE2]), associated with ADHD (p value = 2.73E-05). This variant was also associated with perivascular volumes (Virchow–Robin spaces; p values < 1E-03). No associations were found when using dichotomous definition. Conclusion: We suggest that an appropriate modeling of ADHD symptoms increases statistical power to establish significant risk factors.
Objectives: The current study aims to compare retinal nerve fiber layer (RNFL) thickness, macular thickness, and macular volume between children with ADHD and a control group. Method: The study group included children with ADHD and the control group consisted of age- and gender-matched participants without any psychiatric disorder. In all participants, RNFL thickness, macular thickness, and macular volume were measured by using spectral domain–optical coherence tomography (SD-OCT). ADHD symptom severity was evaluated by using parent-report measures, including Conners’ Parent Rating Scale–Revised: Short Form (CPRS-R: S) and the Strengths and Difficulties Questionnaire: Parent Form (SDQ: P). Results: We compared 90 eyes of 45 children with ADHD and 90 eyes of 45 controls. ADHD group had significantly lower RNFL thickness only in nasal quadrant than the controls. The remaining RNFL quadrants, macular thickness, and volume were not significantly different between groups. There was a reverse correlation between RNFL thickness and ADHD symptom severity. Conclusion: This is the first study examining the RNFL thickness in ADHD. Our findings showed that nasal RNFL thickness was lower, indicating reduced unmyelinated axons in the retina of children with ADHD. The results of this study support the evidence that ADHD involves a lag in cortical maturation and this is measurable in the retina.
Objective: This study examines the relationship between maintenance of improved executive functioning (EF) in adults with ADHD with long-term symptom improvement with atomoxetine. Method: Data were collected from a yearlong, double-blind, placebo-controlled clinical study on adult patients with ADHD receiving atomoxetine (80-100 mg/day) for 24 weeks. Patients were then randomized to continue atomoxetine or placebo for 6 months. Executive functioning was rated with Behavior Rating Inventory of Executive Function–Adult Version: Self-Report™ (BRIEF-A: Self-Report™), and the T-scores were determined. Results: Postrandomization T-scores for atomoxetine patients were significantly better than those of placebo patients (3 and 6 months postrandomization). Patients with greater improvements in EF were more likely to show worsening of EF and to relapse after atomoxetine discontinuation. The maintenance of improved EF was significantly associated with improved ADHD symptoms (Conners’ Adult ADHD Rating Scale–Investigator Rated: Screening Version [CAARS-Inv:SV] with adult prompts). Conclusion: Treatment with atomoxetine improved EF during the treatment phases. Improved EF was maintained up to 6 months after discontinuation of atomoxetine.
Objective: Clinical utility of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) was examined in 1,381 clinically referred youth (62.5% male, 5 to 18 years) with and without ADHD symptoms. Method: Participants included children with restricted inattentive symptoms (IA only), restricted hyperactivity/impulsivity symptoms (HI only), symptoms in both domains (Combined), and non-ADHD clinical comparison. Results: Greater hyperactivity (Combined, HI only) was associated with higher Behavior Regulation (BRI) and Emotion Regulation (ERI) scores, whereas greater inattentiveness (IA only, Combined) was associated with higher Cognitive Regulation scores. Effect sizes were largest for Inhibit, Working Memory, and Organization of Materials scales; these scales discriminated children with and without ADHD symptoms and restricted inattentive and hyperactive presentations. Conclusion: The BRIEF2 distinguishes associated features of ADHD and the day-to-day executive impact. Sensitivity was consistently poorer than specificity. The referred nature of the sample and examination of restricted presentations suggest additional work is needed to examine whether ERI and BRI are dissociable.
Objective: ADHD persists in up to 60% into adulthood, and the reasons for persistence are not fully understood. The objective of this study was to characterize the neurofunctional basis of decision making in those with a childhood diagnosis of ADHD with either persistent or remitted symptoms in adulthood versus healthy control participants. Method: Thirty-two adults diagnosed with ADHD as children were split into persistent (n = 18) or remitted (n = 14) ADHD groups. Their neural activity and neurofunctional connectivity during a probabilistic reversal learning task were compared with 32 healthy controls. Results: Remitters showed significantly higher neural connectivity in final reversal error and probabilistic error conditions, and persisters depict higher neural connectivity in reversal errors than controls at a family-wise error (FWE) corrected whole-brain corrected threshold. Conclusion: Remitters may have utilized higher neural connectivity than controls to make successful decisions. Also, remitters may have utilized compensatory strategies to override any potential underlying ADHD deficits.
Objective: This study evaluated the functional networks of amygdala subregions (basolateral [BLA], centromedial [CMA], and superficial amygdala [SFA]) in ADHD and their association with emotional lability (EL) symptoms. Method: Resting-state functional connectivity (RSFC) of amygdala subregions and their correlations with EL scores were evaluated in 35 drug-naïve boys with ADHD and 30 age-matched healthy controls (HC). Results: Compared with HC, altered RSFC were detected differently for each amygdala subregion in ADHD: altered RSFC of BLA with the thalamus and vermis; aberrant RSFC of CMA with the superior temporal gyrus/pole and insula, precuneus and cerebellum; reduced RSFC of SFA with dorsal frontoparietal cortices. Within ADHD, higher EL scores were associated with reduced negative RSFC of SFA with the dorsolateral prefrontal cortex and inferior parietal lobe. Conclusion: Diffuse alterations of amygdala subregion-based networks are associated with ADHD, and the weaker SFA–frontoparietal networks might be involved in the hypothesized top–down effortful regulation of emotion.
Objective: This study tests the hypotheses that (a) adolescents and adults with ADHD score lower on two normed measures of verbal working memory, relative to their overall verbal abilities, than the general population and (b) a specific story memory test is a more sensitive and relevant measure of working memory impairment than a numerically based test. Method: Scores on normed story memory and numerical memory tests of 220 adolescents and adults with ADHD were corrected for the individual’s verbal abilities and compared with each other and national norms. Results: Participants with ADHD scored significantly below their verbal ability measure on both verbal and numerically based memory tests in comparison with national norms. Scores on verbal memory test were lower than scores for numerically based memory tests. Conclusion: This story memory test is a more sensitive measure of working memory impairments in adolescents and adults with ADHD than measures based on recall of numerical data.
Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.
Objective: The objective was to reveal the relationship between dose and concentration of atomoxetine. Method: Fifty-five blood samples of 33 patients with ADHD were examined using high-performance liquid chromatography. Results: The plasma concentrations were 53.2 ± 67.0, 298.0 ± 390.5, and 639.3 ± 831.9 ng/mL at doses of 40 mg, 80 mg, and 120 mg, and the concentration/dose were 1.33 ± 1.67, 3.73 ± 4.88, and 5.33 ± 6.93 ng/mL/mg, respectively. Statistical analyses revealed a significant correlation between the concentration and the dose of atomoxetine (p = .004), and a trending toward significance in the difference in the concentration/dose in the three dosage groups (p = .064). The concentration/dose at 40 and 80 + 120 mg/day were 1.33 ± 1.67 and 4.22 ± 5.53 ng/mL/mg, the latter was significantly higher than the former (p = .006), which suggested non-linear pharmacokinetics. Conclusion: Clinicians should carefully titrate in high dose atomoxetine treatment.
Objective: In a community-based study, we examined parenting style and its relationship to functioning in 6- to 8-year-old children (n = 391; 66.2% male) with ADHD (n = 179), compared with non-ADHD controls (n = 212). Method: Parenting style was assessed using parent-reported (93.5% female) measures of warmth, consistency, and anger. Child socio-emotional and academic functioning was measured via parent- and teacher-reported scales, and direct academic assessment. Results: Parents reported less consistency and more anger in the ADHD group compared with non-ADHD controls, with no differences in warmth. Parenting warmth, consistency, and anger were associated with parent-reported aspects of socio-emotional functioning for children with ADHD and non-ADHD controls, after adjusting for socio-demographic variables, externalizing comorbidities, and ADHD symptom severity. Parenting style was no longer related to academic functioning and most teacher-reported outcomes after adjustment. Conclusion: Generic parenting interventions that promote warm, consistent, and calm parenting may help alleviate socio-emotional impairments in children with ADHD.
Objective: Several studies report that ADHD is associated with reduced gray matter (GM), whereas others report no differences in GM volume between ADHD patients and controls, and some even report more GM volume in individuals with ADHD. These conflicting findings suggest that reduced GM is not a universal finding in ADHD, and that more research is needed to delineate with greater accuracy the range of GM alterations. Method: The present study aimed to identify GM alterations in ADHD using pediatric templates. 19 drug-naïve ADHD patients and 18 controls, all aged 7 to 14 years, were scanned using magnetic resonance imaging. Results: Relative to the controls, the ADHD patients had more GM, predominantly in the precentral and supplementary motor areas. Moreover, there were positive correlations between GM volume in these areas and ADHD scale scores. Conclusion: The clinical and pathophysiological significance of increased GM in the motor areas remains to be elucidated by additional research.
Objective: Individuals with ADHD have been shown to prefer smaller sooner over larger later rewards. This has been explained in terms of abnormally steeper discounting of the value of delayed reinforcers. Evidence for this comes from different experimental paradigms. In some, participants experience delay in the laboratory (real-time delay tasks; R-TD), in others they imagine the delay to reinforcers (hypothetical delay tasks; HD). Method: We directly contrasted the performance of 7- to 12-year-old children with ADHD (n = 23) and matched controls (n = 23) on R-TD and HD tasks with monetary rewards. Results: Children with ADHD displayed steeper temporal discounting on the R-TD, but not the HD tasks. Conclusion: These findings suggest that the experience of waiting prior to the delivery of rewards is an important determinant of heightened temporal discounting in ADHD—a finding consistent with models that emphasize the aversive nature of delay for children.
Objective: To examine the psychometric properties of a German adaptation of the Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P) in a clinical sample of children (4-12 years) with externalizing behavior disorders. Method: Data were collected within two clinical trials (N = 264). Factorial validity, reliability, and divergent validity from symptoms of ADHD and oppositional defiant disorder (ODD) were assessed. Results: Confirmatory factor analyses revealed that a bifactor model consistent with the theoretical assumption of a general construct of impairment (total scale) and additional specific factors (subscales) provided satisfactory data fit. Model-based reliability estimates showed that both the general construct and specific factors accounted for item variance. Internal consistencies were >.70, part–whole corrected item–scale correlations mostly >.30. Correlations between the WFIRS-P Scales and ADHD and ODD symptoms were low to moderate. Conclusion: The results support the factorial validity, reliability, and divergent validity of the WFIRS-P.
Objective: To investigate gender differences in self-reported ADHD symptoms in a group of adults with ADHD and a control group. Methods: A total of 682 adults with ADHD (49.9% females) and 882 controls (59.2% females) completed the Adult ADHD Self-Report Scale (ASRS), listing the 18 symptoms included in the diagnostic criteria of ADHD. Results: Within the ADHD group, females reported more severe symptoms of inattention and hyperactivity/impulsivity than males. This higher symptom report of females was not found in the control group, where the number of severe inattention symptoms rather was higher in males. Conclusion: The results suggest that childhood symptoms of ADHD may have gone unnoticed in girls, emphasizing the need for longitudinal studies of ADHD symptoms across the life span.
Objective: This study evaluated the diagnostic application of continuous performance tests in children with ADHD. Method: We recruited 114 children (aged 6-12) from August 2012 to May 2014. Seventy-nine children were diagnosed with ADHD and 35 were enrolled as controls. The Advanced Test of Attention (ATA) was administered to all participants. Results: There were significant between-group differences for the frequency distribution of four ATA variables. The ATA criteria yielded a diagnostic sensitivity and specificity of 84.8% and 45.7%, respectively. Discriminant analysis revealed that auditory reaction time variability and visual commission errors helped distinguish between the groups. Discriminate functions indicated correct classification of 64.9% children. ADHD children tended to have lower intra-class correlation coefficients. Conclusion: Our results suggest that the ATA distributions of ADHD individuals may differ from the general population; in addition, the ATA results could not independently diagnose ADHD. Therefore, they should be considered carefully before diagnosis.
Objective: This study reassessed adolescents and young adults (15-22 years old) who received individually tailored multimodal treatment for ADHD (behavior therapy and/or stimulant medication) during childhood 6 to 12 years after treatment (M = 8.8 years, SD = 1.6). Method: All participants (N = 75) provided information about their social functioning. Most parents (83%) completed behavior rating scales. Results: Participants demonstrated significant improvement in behavior during the follow-up period with effect sizes on ADHD symptoms of d = 1.2 and 68% of the former patients in the normal range at follow-up. Participants reported elevated rates of grade retention (51%), school dropout (13%), special education service use (17%), school change (47%), and conviction (16%), but few were unemployed (4%). Conclusion: This study provides evidence that the effects of individually tailored multimodal treatment for ADHD in childhood are maintained into adolescence and young adulthood. No hints could be found that continued medication results in a more favorable long-term outcome.
Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions (ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.
Objective: The current study sought to establish psychometric properties of the ADHD-FX (a culturally sensitive measure designed to assess functional impairment related to ADHD) in a dual-site clinical sample. Method: We analyzed patient charts of 67 children (47 boys and 20 girls, ages 5 to 15 years) receiving comprehensive assessments from two university-based ADHD clinics. Results: The parent and teacher ADHD-FX rating scales demonstrated good psychometric properties via adequate reliability (Cronbach’s α > .70), convergent construct validity (significant correlations with majority of theoretically related measures), and divergent construct validity (insignificant correlations with majority of theoretically unrelated measures). Conclusion: Results extend upon previously published psychometric analyses to suggest that the ADHD-FX is a reliable and valid measure for parents and teachers to assess functional impairment related to ADHD (i.e., difficulties with academic achievement, social competence, and familial relationships) in community and clinical populations. Clinical implications and future directions are discussed.
Objective: ADHD may predispose to obesity, a metabolic syndrome component. Affective disorders are also associated with MetSyn and ADHD. This study examined whether ADHD confers any added risk of MetSyn and obesity-related associations in a large sample with varying stages of affective disorders. Method: Participants included 2,303 adults from the Netherlands Study of Depression and Anxiety. Three groups were compared (controls, those with depressive/anxiety disorders without ADHD; and those with depressive/anxiety disorders and ADHD) for presence of MetSyn risk factors, body mass index, and waist–hip ratio. ADHD symptoms were identified by using a T-score > 65 (Conners Adult ADHD Rating Scale). Results: Multivariable analyses were additionally adjusted for sociodemographic, lifestyle, health factors, and affective disorders. Analyses showed no significant association between MetSyn, obesity-related variables, and comorbid ADHD. High Inattention and Hyperactivity/Impulsivity symptoms were not associated with MetSyn. Conclusion: This study did not confirm that MetSyn and obesity-related parameters are increased in comorbid ADHD.
Objective: This study investigated the effectiveness of the Positivity & Rules Program (PR program), a behavioral teacher program targeting ADHD symptoms in the classroom involving both student-focused and classroom-focused programs. Method: Primary school children with ADHD symptoms (N = 114) were randomly assigned to the PR program (n = 58) or control group (n = 56). Teacher and parent ratings were used to assess behavioral, social, and emotional functioning at baseline, during and after the intervention. Intervention effects were assessed using intention-to-treat multilevel analyses. Results: Teachers reported positive effects on ADHD symptoms and social skills (.01 < f2 > .36). Effects did not generalize to the home setting. Conclusion: The PR program holds promise for improving classroom behavior in children with ADHD symptoms and might prevent escalation of problem behavior
Objective: This research investigated the on-road driving performance of individuals with ADHD across a range of road and traffic conditions to determine whether errors were linked to situational complexity and attentional demands. Method: The everyday driving performance of medicated drivers with ADHD, unmedicated drivers with ADHD, and controls was tested in urban, residential, rural, and highway environments using driver license testing procedures. Results: Unmedicated drivers with ADHD displayed fewer safe driving skills and committed more inattentive and impatient driving errors, particularly in low demand highway and rural driving conditions. Medicated drivers’ performance was not reliably different than controls. Participants in both ADHD groups were more likely than controls to report risky driving and involvement in crashes. Conclusion: The results demonstrate that situations with low attentional demand are particularly risky for unmedicated ADHD drivers and suggest that focus on these situations may be useful in improving driving outcomes for this population.
Objective: This study investigated the role of child and parental factors in maltreatment of children with ADHD compared with a healthy control group. Method: We examined the rates and correlations of child maltreatment by parents in a sample of children with ADHD (n = 100) and a matched comparison sample of children without ADHD (n = 100), all aged 6 to 11 years. Parent and child ratings evaluated demographic characteristics, severity of ADHD symptoms, and childhood trauma exposure. Results: According to regression analysis, maternal hyperactivity/impulsivity and male gender of the child increase the emotional abuse; whereas maternal history of emotional abuse and physical neglect and paternal attention deficit increase sexual abuse, and higher maternal hyperactivity/impulsivity increases emotional neglect of ADHD children. Conclusion: The study’s findings provide strong evidence that the maltreatment of children with ADHD is more associated with parental factors than with the symptoms of ADHD in children.
Objective: ADHD is the most prevalent neurodevelopmental disorder. It is highly heritable and multifactorial, but the definitive causes remain unknown. Abnormal dopamine transporter (DAT) availability has been reported, but the data are inconsistent. The aim of this study was to examine whether DAT availability differs between healthy parents with and without ADHD offspring. Method: Eleven healthy parents with ADHD offspring and 11 age- and sex-matched healthy controls without ADHD offspring were recruited. The availability of DAT was approximated using single-photon emission computed tomography, with [99mTc] TRODAT-1 as the ligand. Results: DAT availability in the basal ganglia, caudate nucleus, and putamen was significantly lower in the parents with ADHD offspring than in the healthy controls without ADHD offspring. Conclusion: The results suggest that ADHD could be heritable via abnormal DAT activities.
Objective: In this study, we investigate the differences between parent and teacher ADHD ratings, and how these ratings relate to perceived stress in children with ADHD. Method: Ratings by parents and teachers with the Swanson, Nolan and Pelham ADHD symptom rating scale (SNAP-IV) were collected from children with a clinical diagnosis of ADHD (n = 137). Also, information on medication was collected. Children (≥11 years of age; n = 64) were invited to complete the Pressure-Activation-Stress scale. Results: Among girls, but not boys, teacher ratings were significantly lower than parental ratings on all symptom scales. Lower teacher ratings on hyperactivity symptoms were associated with higher levels of perceived stress. Conclusion: The findings suggest a potential gender bias in ratings among teachers. Underrated, and hence underidentified, ADHD problems in the school setting seem to increase the perception of stress in the sense of pressure for both girls and boys.
Objective: Effort allocation is a multi-faceted process driving both the decision to choose a high effort–high reward alternative over a low effort–low reward alternative, and the execution of this decision by recruiting sufficient effort. The objectives of our study were to examine whether children with ADHD would (a) show different reward–effort cost trade-off, and (b) have difficulty executing their decision. Method: 50 children, aged 9 to 15, with and without ADHD, had to choose between high effort–high reward and low effort–low reward alternatives using a handheld dynamometer and to execute their choice. Results: Children with ADHD and controls made similar number of high-effort choices (p = .806). However, children with ADHD executed their high-effort choices less frequently compared with controls (p = .029). Conclusion: These findings suggest that children with ADHD are not characterized by different effort–reward trade-off but rather by difficulties in recruiting effort for their preferences implementation.
Objective: Research has identified a relationship between sluggish cognitive tempo (SCT) symptoms and symptoms of ADHD, anxiety, and depression; however, no study has controlled for symptoms of ADHD, anxiety, and depression when examining impairment related to SCT symptoms. This study aimed to examine (a) the extent to which functional impairment and executive function (EF) problems were accounted for by SCT symptoms when controlling for ADHD, anxiety, and depression symptoms, and (b) which type of symptoms were associated with the greatest amount of impairment. Method: College students (N = 458) completed self-report scales of ADHD, SCT, anxiety, and depression symptoms, as well as functional impairment and EF problems. Results: Thirteen percent of the sample was found to have high levels of SCT symptoms. SCT symptoms showed a moderate to strong correlation with the other symptom sets; however, high levels of SCT symptoms often occurred separate from high levels of ADHD, anxiety, or depression symptoms. SCT symptoms accounted for the most unique variance for both EF problems and functional impairment. Students with high levels of SCT symptoms, with or without high levels of ADHD symptoms, exhibited more impairment and EF problems than the controls. Conclusion: SCT is a clinical construct worthy of additional study, particularly among college students.
Objective: This study investigates excessive mind wandering (MW) in adult ADHD using a new scale: the Mind Excessively Wandering Scale (MEWS). Method: Data from two studies of adult ADHD was used in assessing the psychometric properties of the MEWS. Case-control differences in MW, the association with ADHD symptoms, and the contribution to functional impairment were investigated. Results: The MEWS functioned well as a brief measure of excessive MW in adult ADHD, showing good internal consistency (α > .9), and high sensitivity (.9) and specificity (.9) for the ADHD diagnosis, comparable with that of existing ADHD symptom rating scales. Elevated levels of MW were found in adults with ADHD, which contributed to impairment independently of core ADHD symptom dimensions. Conclusion: Findings suggest excessive MW is a common co-occurring feature of adult ADHD that has specific implications for the functional impairments experienced. The MEWS has potential utility as a screening tool in clinical practice to assist diagnostic assessment.
Objective: The aim of the article is to review the evidence that aerobic exercise may be a useful adjunct treatment for ADHD. Method: Studies on physical, cognitive, and psychosocial aspects of aerobic exercise that are relevant to ADHD are reviewed and evaluated. Results: Stimulant medication, the main pharmacotherapy for ADHD, and aerobic exercise both act on catecholamine pathways. Aerobic exercise has been shown to be beneficial in preclinical studies on spontaneous hypertensive rats, an animal model of ADHD, and in clinical trials of children with ADHD, as an adjunct treatment to medication. Social and neurocognitive function in children and adults seem to be positively affected by exercise as well. Nevertheless, no controlled clinical trials in adults with ADHD have been conducted. Conclusion: Aerobic exercise may be a useful non-medication adjunct therapy for ADHD. The clinical effectiveness of aerobic exercise for ADHD in children and adults warrants further clinical studies.
Objective: The primary purpose of this study was to examine the relationship between socioeconomic status (SES) and psychological distress in individuals self-reporting a diagnosis of attention deficit disorder (ADD)/ADHD. Method: This correlational study encompasses cross-sectional data from 488 male and female adults (20-64 years) who reported that they have been diagnosed with ADD/ADHD. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Results: Adults with ADD/ADHD and high incomes have significantly lower K10 scores than Canadians with ADD/ADHD and low incomes. Income, but not education, was significant in predicting psychological distress among the sample. Canadian adults with ADD/ADHD have an increased risk for developing psychological distress and comorbid psychiatric disorders. Conclusion: The findings suggest that negative outcomes associated with ADD/ADHD are not necessarily pervasive. High income may serve as a protective factor for psychological distress among adults with ADD/ADHD.
Objective: The objective of this study was to compare children with ADHD with children without ADHD on frustration tolerance and to examine the role of oppositional defiant disorder (ODD) in frustration tolerance within the sample. Method: Participants included 67 children ages 10 to 14 years-old with (n = 37) and without (n = 30) Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD who completed the Mirror Tracing Persistence Task (MTPT), a validated computerized behavioral measure of frustration tolerance. Results: Children with ADHD were more likely to quit this task than children without ADHD, demonstrating lower levels of frustration tolerance. There were no differences in frustration tolerance between children with ADHD + ODD and those with ADHD – ODD. Moreover, ODD did not moderate the relationship between ADHD and frustration tolerance. Conclusion: Our results suggest that low frustration tolerance is directly linked to ADHD and not better accounted for by ODD. This research highlights specific behavioral correlates of frustration in children with ADHD.
Objective: The aims of the present study were to examine the presence of sluggish cognitive tempo (SCT) symptoms in children; associations of the symptoms with sociodemographic characteristics of the children; and relationships between SCT symptoms and symptoms of ADHD, dyslexia, academic performance, and behavioral problems. Method: We evaluated Catalan schoolchildren aged 7 to 10 years in Barcelona, 2012-2013. Parents filled out the SCT–Child Behavior Checklist (SCT-CBCL), the Strengths and Difficulties Questionnaire (SDQ), and a questionnaire concerning sociodemographic characteristics. Teachers completed the ADHD criteria of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) (ADHD-DSM-IV), a list of dyslexia symptoms, and evaluated the children’s academic performance. SCT symptoms were studied as a continuous and dichotomous variable. Results: In all, 11% of the children in our sample scored above the clinical cut-off on the SCT-CBCL scale. We observed a higher rate of SCT symptoms in boys, children whose father was unemployed, those whose maternal educational level was lower, children with a high socioeconomic vulnerability index at home, those who reported maternal smoking during pregnancy and current second-hand smoke exposure at home, and children with an ADHD diagnosis. More SCT symptoms were associated with inattention symptoms, symptoms of dyslexia, academic problems, and emotional and peer relationship problems. Conclusion: We observed a higher prevalence of SCT symptoms in our sample than expected in the general population. While girls are less prone to SCT symptoms, some socioeconomic indicators, dyslexia, and inattention symptoms as well as exposure to smoking at home increase the risk of SCT and must be taken into account during assessments.
Objective: To assess the functioning of young adults with ADHD in a military setting. Method: In all, 14,655 young adults with ADHD (mean age at first examination 17.8 ± 0.7) attending mandatory service in the Israeli military were compared with matched controls on several functioning domains. Results: Young adults with ADHD had more sessions with mental health care professionals, physician appointments, sick days, and disqualifications of professions than controls (p < .001). Young adults with ADHD were also less medically fit for combat service (odds ratio [OR] = 0.75, 95% confidence interval [CI] = [0.72, 0.79]), more medically unfit for military service in general (OR = 1.26, 95% CI = [1.13, 1.40]), and had higher rates of overweight and obesity (p < .001). In addition, they were more likely to be diagnosed with a personality disorder (OR = 1.29, 95% CI = [1.07, 1.53]) or with minor affective and anxiety disorders (OR = 1.33, 95% CI = [1.06, 1.67]) than matched controls. Conclusion: These results support a negative effect of ADHD on the functioning of young adults in a military setting.
Objective: Research has demonstrated an association between ADHD and intimate partner violence (IPV). However, it is unclear whether adults with ADHD persisting from childhood are especially at risk, and whether ADHD is a unique risk factor beyond well-established predictors of IPV. Method: Adults with (n = 95) and without childhood histories of ADHD (n = 121) who were recruited from Amazon’s Mechanical Turk reported their levels of IPV perpetration and victimization, and provided data on additional risk factors of IPV (e.g., childhood maltreatment, alcohol abuse). Results: While controlling for additional risk factors, adults diagnosed with ADHD as children, particularly those with elevated current ADHD symptoms (ADHD-Persist), reported higher rates of IPV perpetration and victimization than adults with ADHD histories but low current symptoms (ADHD-Desist) and adults who were never diagnosed with ADHD (control). Conclusion: Adults with ADHD histories and elevated current symptoms are most likely to report IPV perpetration and victimization.
Objective: To identify factors associated with discrepancy in parent–teacher reporting of symptoms of ADHD. Method: Parents and teachers rated 1,364 children using an ADHD rating scale. Data were analyzed using multiple regressions and ANOVA. Results: Demographic variables predicted greater parent–teacher discrepancy for ethnic minority families than for Caucasian families. Comorbidity variables predicted greater discrepancy for children who had a comorbid externalizing disorder. Academic performance variables predicted discrepancy for children who showed more homework problems. When all significant predictors were entered together, externalizing disorders and homework problems emerged as significant predictors. Participants whose parents reported higher levels of symptoms were of significantly higher socioeconomic status. Participants whose teachers reported higher levels of symptoms were significantly less likely to have a comorbid externalizing disorder and parent-reported homework problems. Conclusion: Parent–teacher discrepancies are likely to occur when the child has significant homework and externalizing behavior problems.
Objective: The aim of the study was to synthesize the evidence of parent training (PT) as an early intervention for preschool children aged 2.5 to 6 years with ADHD or ADHD symptoms. Method: A systematic review and meta-analysis was conducted. Results: Sixteen studies including 1,003 children were analyzed. Parent-rated outcomes revealed moderate effect sizes (ESs; Hedges’ g) of 0.51 for ADHD symptoms, 0.4 for conduct problems, and 0.63 for negative parenting. Based on independent assessment, results were only significant for negative parenting. Parent-rated outcomes were sustained at follow-ups of 3 to 12 months. Program type, intervention modality, and child diagnostic status did not moderate the effect. Conclusion: PT was partially supported as an efficacious intervention for preschool children with ADHD or ADHD symptoms with moderate ESs on parent-rated outcomes, but no significant results on independently assessed ADHD symptoms.
Objective: Common methods for clinical diagnosis include clinical interview, behavioral questionnaires, and neuropsychological assessment. These methods rely on clinical interpretation and have variable reliability, sensitivity, and specificity. The goal of this study was to evaluate the utility of machine learning in the prediction and classification of children with ADHD–Combined presentation (ADHD-C) using brief neuropsychological measures (d2 Test of Attention, Children with ADHD-C and typically developing control children completed semi-structured clinical interviews and measures of attention/concentration and parents completed symptom severity questionnaires. Method: We used a forward feature selection method to identify the most informative neuropsychological features for support vector machine (SVM) classification and a decision tree model to derive a rule-based model. Results: The SVM model yielded excellent classification accuracy (100%) of individual children with and without ADHD (1.0). Decision tree algorithms identified individuals with and without ADHD-C with 100% sensitivity and specificity. Conclusion:This study observed highly accurate statistical diagnostic classification, at the individual level, in a sample of children with ADHD-C. The findings suggest data-driven behavioral algorithms based on brief neuropsychological data may present an efficient and accurate diagnostic tool for clinicians.
Objective: This is the first study to examine self-reported seasonal differences in the severity of ADHD symptoms in adults from the general population. Method: Data were analyzed from N = 5,303 respondents participating in the second wave of the Netherlands Mental Health Survey and Incidence Study–2, a population-based study on mental health. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale Screener. As indicators of the severity of ADHD symptoms, the total ADHD symptom score and inattention and hyperactivity subscale scores were examined. Results: Compared with participants who were assessed in autumn, total ADHD and inattention subscale scores were significantly higher among participants who were assessed in spring or summer; the hyperactivity subscale score was significantly higher in spring. Conclusion: We found seasonal variations in the severity of ADHD symptoms, which was highest in those assessed in spring and summer. Researchers should be aware of this in the diagnostic process.
Objective: To examine the association between variants of N-methyl-D-aspartate (NMDA) receptor subunit-encoding genes (GRIN2A and GRIN2B) and continuous performance test (CPT) variables in ADHD and healthy controls. Method: In all, 253 ADHD patients and 98 controls were recruited. The diagnosis, genotype, and diagnosis–genotype interaction effects for the CPT variables were examined. Results: Significant diagnosis effects were detected for all CPT variables. There were significant genotype and interaction effects on response time variability (RTV) by the GRIN2B variant. The C/C subgroup had higher RTV than the C/T + T/T subgroup in ADHD, but not in controls. There were significant genotype effects on omission errors by the GRIN2A variant. The G/G subgroup had more omission errors than the G/A + A/A subgroup in ADHD patients, but not in controls. Conclusion: These results suggest that the genetic variants of GRIN2B and GRIN2A confer an increased susceptibility to attentional impairment in ADHD patients.
Objective: The recent rise in ADHD has prompted concerns about adolescents with ADHD diverting and/or misusing stimulants. This is the first study to assess physician perceptions of the pervasiveness of these issues. Method: Questionnaires were mailed to a national sample of pediatric subspecialists. Responses were analyzed (n = 826; 18% response rate) using descriptive statistics and regression analyses. Results: In the past year, 59% of physicians suspected ≥1 patient(s) with ADHD diverted stimulants. Seventy-four percent believed ≥1 patient(s) feigned symptoms to obtain an initial ADHD diagnosis; 66% believed ≥1 patient(s) wanted stimulants to improve academic performance. Child and adolescent psychiatrists were most likely to suspect diversion and feigning symptoms. Thirty-nine percent of physicians believed diversion was at least "common." Conclusion: Although many physicians suspected stimulant diversion and misuse, a substantial number were unaware of these issues, and subspecialist perceptions varied. These findings support the potential pervasiveness of these issues and the need for increased physician awareness.
Objective: It is widely accepted that patients with ADHD exhibit greater susceptibility to distractors, especially during tasks with higher working memory load demands. However, no study to date has specifically measured the impact of distractors on timing functions, although these have consistently shown alterations in ADHD. In this investigation, we aimed to elucidate the neural mechanisms mediating distractor effects on timing functions. Method: We employed a time estimation functional magnetic resonance imaging (fMRI) paradigm including a distracting element in half of the trials in a sample of 21 patients with ADHD and 24 healthy controls. Results: As expected, the effect of the distractor was greater in ADHD patients, where it was associated with increased orbitofrontal activity compared with controls. Behaviorally, time estimation performance benefited from the presence of distractors in both groups. In turn, such improvement correlated with medial frontal and insular activity in the brain. Conclusion: These results suggest that distractors could be stimulating recruitment of frontal resources in ADHD, thus contributing to increase focus on the task.
Objective: The aim of this study was to estimate the prevalence and probabilities of comorbidities between self-reported ADD/ADHD and smoking, alcohol binge drinking, and substance use disorders (SUDs) from a national Canadian sample. Method: Data were taken from the Public Use Microdata File of the 2012 Canadian Community Health Survey–Mental Health (N = 17 311). The prevalence of (a) smoking, (b) alcohol binge drinking, and (c) SUDs was estimated among those with an ADD/ADHD diagnosis versus those without an ADD/ADHD diagnosis. Results: After controlling for potential socioeconomic and mental health covariates, self-reported ADD/ADHD acted as a significant predictor for group membership in the heaviest smoking, heaviest drinking, and heaviest drug usage categories. Conclusion: Individuals self-reporting a diagnosis of ADD/ADHD were found to have a significantly higher likelihood of engaging in smoking and alcohol binge drinking, and were more likely to meet criteria for SUDs than individuals not reporting an ADD/ADHD diagnosis.
Objective: This study compares the performance in a continuous performance test within a virtual reality classroom (CPT-VRC) between medicated children with ADHD, unmedicated children with ADHD, and healthy children. Method: N = 94 children with ADHD (n = 26 of them received methylphenidate and n = 68 were unmedicated) and n = 34 healthy children performed the CPT-VRC. Omission errors, reaction time/variability, commission errors, and body movements were assessed. Furthermore, ADHD questionnaires were administered and compared with the CPT-VRC measures. Results: The unmedicated ADHD group exhibited more omission errors and showed slower reaction times than the healthy group. Reaction time variability was higher in the unmedicated ADHD group compared with both the healthy and the medicated ADHD group. Omission errors and reaction time variability were associated with inattentiveness ratings of experimenters. Head movements were correlated with hyperactivity ratings of parents and experimenters. Conclusion: Virtual reality is a promising technology to assess ADHD symptoms in an ecologically valid environment.
Objective: There are indicators that parental psychological factors may affect how parents evaluate their child’s quality of life (QoL) when the child has a health condition. This study examined the impact of parents’ perceived stress on parent and child ratings of the QoL of children with ADHD. Method: A cross-sectional sample of 45 matched parent–child dyads completed parallel versions of the KIDSCREEN-27. Children were 8 to 14 years with clinician diagnosed ADHD. Results: Parents who rated their child’s QoL lower than their child had higher perceived stress scores. Parent stress was a unique predictor of child QoL from parent proxy-rated but not child-rated QoL scores. Conclusion: Parents’ perceived stress may play an important role in their assessments of their child’s QoL, suggesting both parent and child perspectives of QoL should be utilized wherever possible. Interventions that target parent stress may contribute to improvements in the child’s QoL.
Objective: This study evaluated the efficacy of an Integrated Brain, Body, and Social (IBBS) intervention for children with ADHD. Treatment consisted of computerized cognitive remediation training, physical exercises, and a behavior management strategy. Method: Ninety-two children aged 5 to 9 years with ADHD were randomly assigned to 15 weeks of IBBS or to treatment-as-usual. Primary outcome measures included blinded clinician ratings of ADHD symptoms and global clinical functioning. Secondary outcome measures consisted of parent and teacher ratings of ADHD and neurocognitive tests. Results: No significant treatment effects were found on any of our primary outcome measures. In terms of secondary outcome measures, the IBBS group showed significant improvement on a verbal working memory task; however, this result did not survive correction for multiple group comparisons. Conclusion: These results suggest that expanding cognitive training to multiple domains by means of two training modalities does not lead to generalized improvement of ADHD symptomatology.
Objective: This study aimed to examine the influence of dopamine transporter gene (DAT1) 3’UTR genotype on cingulate cortical thickness in a large sample of children and adolescents with ADHD. Method: Brain MRIs were acquired from 46 ADHD patients with homozygosity for the 10-repeat allele and 52 ADHD patients with a single copy or no copy of the allele. The cingulate cortex of each MRI scan was automatically parceled into sulci and gyri as well as into Brodmann areas (BA). Results: There were no group differences in age, gender, full-scale intelligence quotient, symptom severity, treatment status, comorbidity, or mean overall cortical thickness. Sulcus/gyrus- and BA-based analyses revealed that patients homozygous for the 10-repeat allele showed significantly greater thickness in right cingulate gyrus and right BA 24 compared with 9-repeat carriers. Conclusion: These findings suggest that thickness of cingulate cortex is influenced by the presence of the 10-repeat allele in ADHD.
Objective: The objective was to assess the clinical utility of the Adult ADHD Self-Report Scale (ASRS-v1.1) in identifying ADHD in alcoholics using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) as the diagnostic "gold standard." Method: We performed a secondary analysis of data from 379 treatment-seeking alcoholics who completed the ASRS-v1.1 and the ADHD module of the PRISM. Data analysis included descriptive statistics. Results: The prevalence of ADHD was 7.7% (95% CI = [5.4, 10.8]). The positive predictive value (PPV) of the ASRS-v1.1 was 18.1% (95% CI = [12.4, 25.7]) and the negative predictive value (NPV) was 97.6% (95% CI = [94.9, 98.9]). The ASRS-v1.1 demonstrated a sensitivity of 79.3% (95% CI = [61.6, 90.2]) and a specificity of 70.3% (95% CI = [65.3, 74.8]). Conclusion: The ASRS-v1.1 demonstrated acceptable sensitivity and specificity in a sample of treatment-seeking alcoholics when compared with the PRISM as the reference standard for ADHD diagnosis.
Objective: This study investigated the relationship between parental affective temperaments and the oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms of children with ADHD. Method: The sample consisted of 542 treatment-naive children with ADHD and their biological parents. Children were assessed via both parent- and teacher-rated behavioral disorder scales. Parental affective temperament and ADHD symptoms were measured by self-report inventories. The relationships between psychiatric variables were evaluated using structural equation modeling. Results: According to parent-rated behavioral disorder scales, paternal cyclothymic and maternal irritable temperaments were associated with ODD scores, and maternal depressive temperament was associated with CD scores. In terms of teacher-rated behavioral disorder scales, maternal anxious temperament was associated with ODD scores, and paternal cyclothymic and maternal depressive temperaments were associated with CD scores. Conclusion: These results suggest that certain parental affective temperaments are related to an increase in symptoms of disruptive behavioral disorders in children with ADHD.
Objective: The objective of the study is to examine whether children aged 7 to 11 years with very well-characterized ADHD, recruited from the community, have a similar number of healthy lifestyle behaviors as compared with typically developing children from the same community. Method: Parents of children with (n = 184) and without (n = 104) ADHD completed a lifestyle questionnaire asking about water intake, sweetened beverage consumption, multivitamin/supplement use, reading, screen time, physical activity, and sleep. A lifestyle index was formed from these seven domains (0-7), and multivariable ordered logistic regression was used to examine the association of ADHD status and total healthy lifestyle behaviors. Results: Children with ADHD were almost twice as likely to have fewer healthy behaviors, even after adjustment for age, sex, intelligence quotient (IQ), ADHD medication use, household income, and four comorbid psychiatric disorders (odds ratio [OR] [95% confidence interval] = 1.95 [1.16, 3.30], p = .01). Conclusion: Future research is needed to assess the effects of a combined lifestyle intervention in this group.
Objective: The aim of this study was to assess for the first time the criterion validity of the semi-structured Diagnostic Interview for ADHD in adults (DIVA 2.0), and its concurrent validity in comparison with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and other ADHD severity scales, following the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Method: A transversal study was performed on 40 out-patients with ADHD to check the criteria and concurrent validity of the DIVA 2.0 compared with the CAADID. Results: The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview. The concurrent validity demonstrated good correlations with three self-reported rating scales: the Wender Utah Rating Scale (WURS; r = .544, p < .0001), the ADHD-Rating Scale (r = .720, p < .0001), and Sheehan’s Dysfunction Inventory (r = .674, p < .0001). Conclusion: The DIVA 2.0 is a reliable tool for assessing and diagnosing Adult ADHD and is the only one that offers free online access for clinical and research purposes.
Objective: Conflict monitoring is well known to be modulated by context. This is known as the Gratton effect, meaning that the degree of interference is smaller when a stimulus–response conflict had been encountered previously. It is unclear to what extent these processes are changed in ADHD. Method: Children with ADHD (combined subtype) and healthy controls performed a modified version of the sequence flanker task. Results: Patients with ADHD made significantly more errors than healthy controls, indicating general performance deficits. However, there were no differences regarding reaction times, indicating an intact Gratton effect in ADHD. These results were supported by Bayesian statistics. Conclusion: The results suggest that the ability to take contextual information into account during conflict monitoring is preserved in patients with ADHD despite this disorder being associated with changes in executive control functions overall. These findings are discussed in light of different theoretical accounts on contextual modulations of conflict monitoring.
Objective: To examine the effects of neighborhood socioeconomic disadvantage and ethnic composition on the utilization of ADHD medication in schoolchildren after accounting for individual- and family-level characteristics. Method: A cohort of all schoolchildren living in Stockholm County was prospectively followed for new prescriptions of ADHD medication (N = 276,955). Three-level logistic regression models were used with individual/family characteristics (e.g., immigrant background) at the first level and small area market statistics (SAMS) and municipality characteristics (i.e., socioeconomic disadvantage and ethnic composition) at the second and third level. Results: SAMS socioeconomic disadvantage was associated with increased utilization of ADHD medication. The utilization of ADHD medication was lower among immigrant children as compared with natives, and their odds of not utilizing medication increased as the degree of concentration of foreign-born increased. Conclusion: These results suggest that interventions at the neighborhood level may offer an additional route for the prevention of the disorder and/or alleviation of its consequences.
Objective: We investigated whether ADHD children who are positive to Purkinje cell antibodies display pro-inflammatory activity associated with high cytokine serum levels. Method: Fifty-eight ADHD outpatients were compared with 36 healthy, age- and sex-matched children. Forty-five of the ADHD children were positive to anti-Yo antibodies, whereas 34 of the control children were negative. Interleukin 4 (IL-4), IL-6, IL-10, IL-17, tumor necrosis factor alpha (TNFα), and interferon gamma (IFN) cytokine serum levels were tested in ADHD children who were positive to anti-Yo antibodies and in the control children who were negative. Results: Anti-Yo antibodies were present to a greater extent in the ADHD group: 77.58% versus 22.42%. Significant differences emerged between the two groups in IL-6 and IL-10, with higher cytokine levels being detected in ADHD children than in controls. Conclusion: Immune processes in ADHD are likely to be associated with mediators of inflammation, such as cytokines. These results contribute to our understanding of action of neural antibodies and cytokines in ADHD.
Objective: The aim of the study was to hierarchically assess the predictive power of low and high birth weight, pre-term and post-term birth, and low Apgar score as the risk factors for ADHD. Method: The data of 132 boys diagnosed with ADHD and 146 boys from control group, aged 6 to 18 years, have been analyzed. The boys were categorized according to term of birth, birth weight, and Apgar score. CART method (Classification and Regression Trees) was used for assessment of the relationship between perinatal factors and the risk of ADHD. Results: Low Apgar score (21.97% vs. 13.01%) and post-term birth (12.12% vs. 0.68%) were more frequent in the sample than in the control group. CART method additionally indicated low birth weight as associated with the risk of ADHD. Among analyzed risk factors, Apgar score had the highest predictive value. Conclusion: The decreased Apgar score is the most important perinatal risk factor of ADHD. Research results also indicated a high significance of post-term birth in predicting the disorder.
Objective: To estimate the prevalence of ADHD and determine an effective screening test for ADHD in a population-seeking treatment for cannabis use disorders. Method: The Conners Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; CAADID) was used to generate sensitivity and specificity data for ADHD screening tests, which were then administered to 99 participants seeking treatment for cannabis use disorders to estimate ADHD prevalence. Results: The prevalence estimated from the Wender Utah Rating Scale (WURS) was 45% (sensitivity = 0.88, sensitivity of 0.75), from the Conners Adult ADHD Rating Scale (CAARS) 34% (sensitivity = 0.80, specificity = 0.91), from the WURS + CAARS 36% (sensitivity = 0.71, specificity = 0.95), and from the Adult ADHD Self-Report Scale (ASRS) 46% (sensitivity = 0.61, specificity = 0.86). Conclusion: The prevalence of ADHD in adults seeking treatment for cannabis use disorders is estimated to be between 34% and 46%. The WURS paired with the CAARS provides excellent sensitivity and specificity for the diagnosis of ADHD in this population.
Objective: The social disability associated with ADHD often makes diagnostic and treatment decision making challenging. This protocol investigates the test performance of the Autism Mental Status Exam (AMSE) in detecting autism spectrum disorder (ASD) in a sample of 45 children with ADHD and ASD symptomatology. The AMSE is a brief ASD diagnostic assessment administered in the context of a clinical exam. Method: All participants received a developmental evaluation, including the AMSE, followed by independent gold standard diagnostic assessments including the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview–Revised (ADI-R). Results: Receiver operating characteristics (ROC) curve analysis indicated strong sensitivity and specificity in this population. Optimal cutoff scores are provided. Conclusion: The AMSE holds promise as a brief ASD assessment tool for children with ADHD and ASD symptomatology and as a guide for treatment and referral decisions at the point of care.
Objective: To compare the eye movement patterns of adults with ADHD with those of controls as they perform the Stroop test. Method: Thirty individuals with ADHD (ages 18-31), and 30 controls participated in this study. The hypothesis was that under the incongruent condition, the group with ADHD would focus longer on the distracter than the controls. Results: Participants with ADHD showed a more pronounced Stroop effect than the controls. Eye movements indicated that more time was spent fixating on the target than on the distracter. The most significant differences between the groups were the overall time spent on the target and the number of fixations on the target, rather than on the distracter. Furthermore, the group with ADHD made more transitions between the target and distracter stimuli. Conclusion: These results were interpreted to indicate an inefficient strategy used by the group with ADHD in their attempt to ignore the distracter stimuli.
Objective: ADHD is associated with elevated rates of comorbid depressive disorders, yet the nature and development of this comorbidity remain understudied. We hypothesized that a longer period of prior ADHD treatment, being less likely to engage in maladaptive cognitive/behavioral coping strategies, and less severe ADHD symptoms would predict greater likelihood of lifetime resilience to depression. Method: Seventy-seven adults with ADHD completed diagnostic interviews, clinician-administered symptom rating scales, a stressful life events measure, and self-report questionnaires. We used logistic regression analyses to identify factors associated with resilience to depression. Results: Adults with more extensive ADHD treatment histories were more likely to be resilient to depression. Those who were less likely to report ruminative thinking patterns and cognitive-behavioral avoidance were also more resilient. Severity of current or childhood ADHD symptoms and recent negative life events did not predict resilience. Conclusion: Results identify protective factors that may promote the resiliency to ADHD-depression comorbidity.
Objective: The aim of the study was to validate the Norwegian version of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life (AAQoL) scale and to explore Quality of Life (QoL) and functional outcomes in adults with ADHD. Method: A total of 313 adults with ADHD participated in the study. Data were collected from medical records and self-report questionnaires. Confirmatory factor analysis was performed to assess the model fit of the translated AAQoL. Chi-square statistics and t tests were used to investigate sample characteristics. Results: The analyses showed acceptable model fit between data and the model. Chi square = 863.179 (371 df, p < .0000), root mean square error of approximation (RMSEA) = 0.069 (90% confidence interval [CI]), comparative fit index (CFI) = 0.873, and Tucker–Lewis index (TLI) = 0.821. Cronbach’s alpha range for the scales was .761 to .869. The sample was characterized by poor QoL and impairment. Conclusion: The translated AAQoL is showing good initial indications of validity with acceptable psychometric properties in the sample. ADHD was associated with impairments in QoL, symptoms, and functional outcomes.
Objective: The aim of this study was to identify the child and parent/family correlates of anxiety in a community-based sample of children with ADHD. Method: Children (6-8 years) with ADHD (n = 179) and controls (n = 212) were assessed for ADHD and anxiety using the Diagnostic Interview Schedule for Children IV. Potential child and parent/family correlates were measured through direct assessments, and parent- and teacher-reported questionnaires. Associations were examined using univariate and multivariate logistic regression analyses. Results: One in four children with ADHD (n = 44) met criteria for an anxiety disorder, compared with one in 20 controls (n = 10). Anxiety was common in both boys and girls with ADHD. The strongest correlates of anxiety in multivariate analyses were ADHD subtype, primary caregiver psychosocial distress, and neighborhood socioeconomic disadvantage. Conclusion: Anxiety is common in children with ADHD. This study provides insight into the potential parent/family stressors that may increase risk for anxiety in children with ADHD.
Objective: We examined how college students manage ADHD medication and how beliefs regarding the medication and attitudes of friends and families influence adherence on weekdays and weekends during an academic semester. Method: Undergraduate students (n = 53) responded to an online survey to report their adherence, their beliefs about the effects of the medication, and their perception of important others’ views of adherence. Results: Students chose to take more medication on weekdays than weekends. On weekdays, beliefs that the medications enhance academic performance and social skills influenced adherence, and on weekends, beliefs regarding negative side effects were important. The perception that medication leads to a loss of authentic self reduced adherence at both times. Generally, students believed that important others wanted them to take medication. Conclusion: Students were actively weighing the costs and benefits of taking their ADHD medication and consciously adjusting adherence levels from day to day.
Objective: To compare the effects of multimodal therapy including supervised high-intensity interval training (HIIT) with those of standard multimodal therapy (TRAD) concerning key variables of physical fitness (peak power and oxygen uptake), motor skills, social behavior, and quality of life in boys with ADHD. Method: A single-center, two-arm randomized, controlled design was used, with 28 boys (8-13 years of age, IQ = 83-136) being randomly assigned to multimodal HIIT (three sessions/week, 4 x 4-min intervals at 95% of peak heart rate) or TRAD. The Movement Assessment Battery for Children II evaluated motor skills and the German version of the hyperkinetic disorder questionnaire for external evaluation by the guardians (FBB-HKS) or German version of the hyperkinetic disorder questionnaire for self-assessment by the children (SBB-HKS) and the KINDL-R questionnaires mental health and health-related quality of life. Results: Both interventions enhanced peak power, and HIIT also reduced submaximal oxygen uptake. HIIT was more effective than TRAD in improving the total score for motor skills (including manual dexterity and ball skills; p < .05), self-esteem, friends, and competence (p < .05) and, moreover, improved subjective ratings of attention. Conclusion: Three weeks of multimodal therapy including HIIT improved physical fitness, motor skills, certain aspects of quality of life, competence, and attention in boys with ADHD.
Objective: It remains unclear whether daytime impairments in ADHD patients are better explained by an altered level of alertness and/or by cognitive deficits. The aim of this study was to determine the respective contribution of these factors on driving performance in ADHD adults. Method: ADHD adults (n = 39) and healthy controls (n = 18) underwent a nocturnal polysomnography (PSG) followed by a Maintenance of Wakefulness Test (MWT), a simulated driving task, and a neuropsychological evaluation. Results: ADHD patients had shorter mean sleep latency on the MWT and worse driving performance than controls. They also made more errors on attention and executive functioning tests. Logistic regression analyses showed that inhibition deficits and objective daytime sleepiness predicted highway driving performance in ADHD. Conclusion: Our study shows that not only inhibitory control deficits but also pathological level of alertness independently contribute to highway driving impairment in ADHD patients, providing a better understanding of the pathophysiological mechanisms involved in ADHD.
Objective: The aim of this study is to investigate the presence of ADHD and other psychiatric disorders among parents with at least one child with ADHD relative to parents with children who do not have ADHD. Method: Eighty five parents of children with ADHD with 68 control parents who had healthy children without ADHD were interviewed for participation in present study. Each parent was evaluated for co-existing psychiatric disorders using the Structured Clinical Interview for the DSM IV Axis I Disorders (SCID I). Results: We found that ADHD and co-morbid psychiatric symptoms were increased in the parents of children with ADHD in comparison with the healthy control group. Conclusion: Psychiatric co-morbidity was more common among the parents of patients with inattentive and combined presentations. Adult ADHD is associated with psychiatric co-morbidities including anxiety disorders, mood disorders, and somatoform disorders as well as substantial role impairment.
Objective: The object was to examine the prevalence of ADHD among preschoolers, analyzing comorbidity, and the association with socio-demographic factors. Method: We conducted a two-phase epidemiological study of 1,104 preschoolers aged 3 to 6 years in Catalonia, Spain. The Early Childhood Inventory–4 (ECI-4) was administered to parents and teachers. Children at risk of ADHD were assessed using open-ended face-to-face interviews and were observed in a school setting. ADHD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Results: The prevalence of ADHD diagnosis was 5.4%. Male sex and first-born status were risk factors for ADHD. Parents reported more symptoms (12.9%) than teachers (8.7%). Behavioral problems (odds ratio [OR] = 12, p = .001), autism spectrum disorder problems (OR = 9.5, p = .001), and obsessive-compulsive problems and tics (OR = 5.9, p = .001) were specifically related to ADHD diagnosis. Mother’s health status and school achievement were lower in ADHD children. Conclusion: Even at early stages of development, ADHD has high rates of comorbidity and a significant impact on school performance and family health.
Objective: The diagnosis of ADHD in preschool is challenging. Behavioral ratings are less reliable, but the value of neuropsychological tests in the diagnosis of ADHD has been debated. Method: This article provides an overview of neuropsychological measures utilized in preschoolers with ADHD (3-5 years). In addition, the manuscript discusses the extent to which these measures have been tested for their diagnostic capacity. Results: The diagnostic utility of computerized continuous performance tests and working memory subtests from IQ-batteries has been demonstrated in a number of studies by assessing their psychometric properties, sensitivity, and specificity. However, findings from developmental and basic research attempting to describe risk factors that explain variance in ADHD show the most consistent associations of ADHD with measures of delay aversion. Conclusion: Results from developmental research could benefit studies that improve ADHD diagnosis at the individual level. It might be helpful to consider testing as a structured situation for behavioral observation by the clinician.
Objective: We explored the relationship between accidental injuries, motor impairment, and co-occurring autism spectrum disorder (ASD) symptoms in children with ADHD–combined type (ADHD-CT). Method: Participants were 32 male children diagnosed with ADHD-CT and 23 typically developing male children (7-12 years, full scale IQ [FSIQ] > 80). Parents completed a customized questionnaire on the occurrence of accidental injuries (e.g., bruises, cuts) their child experienced in the past 12 months. Motor proficiency was assessed using the Movement ABC–2 (MABC-2). Parents rated motor, ADHD-CT, ASD, and anxiety symptoms. Results: Children with ADHD-CT had significantly increased parent-reported accidental injuries compared with typically developing children. Among children with ADHD-CT, Spearman’s rho rank correlations revealed no association between increased accidental injuries and MABC-2 score, but significant associations with increased hyperactivity/impulsivity, ASD, and anxiety symptoms. Conclusion: Although these findings require validation, they suggest a need for further research investigating the contribution of co-occurring ASD and anxiety symptoms to accidental injuries in children with ADHD-CT.
Objective: The suggested neurobiological bases of ADHD focus on the amygdala as a center of emotions processing. Therefore, we hypothesize that patients with ADHD will show an irregular pattern of emotional-related activity of the amygdala region as well as some structural abnormalities. Method: Nine adult patients with ADHD and nine group-matched healthy volunteers were studied using a 1.5-T magnetic resonance imaging (MRI) scanner. Morphometric measurements were obtained manually, and they were later processed and compared. Absolute volumes of several structures and nuclei were calculated with FSL-FIRST. For the functional magnetic resonance examination, a set of two paradigms was prepared, using a block design, incorporating images of the International Affective Picture System (IAPS). The patients were unmedicated at the time of the MRI scan. Results: Negative correlation was found between the right amygdala volume and Barrat’s impulsivity scores (r = –.756, p = .018). The age of patients did not turn out to be a significant factor. No significantly higher activation areas were found in patients with unpleasant content images. For the left amygdala, an Region Of Interest (ROI)-based analysis showed moderately higher level of activation in the patients than in the controls with pleasant content images. Conclusion: Patients with ADHD tend to have smaller amygdala volumes. ADHD patients presented less activation in the area of the left frontal pole than the controls. There was no amygdala activation stated when presenting the pleasant images. Whereas bigger activation of the left amygdala was found in patients while presenting them unpleasant images. These results might suggest that lower emotional processing and less control of impulsivity is associated with dysfunctional amygdala in ADHD patients.
Objective: The diagnosis of ADHD is based on behavioral criteria, which allow for subjective variability and invite criticism regarding the reality of the disorder. In this situation, more objective criteria would be desirable. We review the scientific literature for diagnostic tests based on event-related potentials (ERPs). Method: Seven studies met the inclusion criteria of reporting the sensitivity and specificity of an ERP-based classifier discriminating participants with ADHD from healthy controls. Study quality was rated using the second version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) system. Results: Overall, study quality was acceptable. The largest biases were lack of representativeness and overfitting. Sensitivities and specificities ranged from 57% to 96%, and 63% to 92%, respectively. However, no two studies used the same diagnostic test. Conclusion: There is a serious lack of coordination in worldwide efforts to find more objective ERP-based criteria for the diagnosis of ADHD. Concerted action is needed.
Objective: In their meta-analysis, Adeyemo et al. reported a strong association between mild traumatic brain injury (mTBI) and ADHD. However, less is understood about why such an association exists. Method: This commentary focuses on the underlying etiologies of both conditions to reveal potential toxic synergisms that could explain this association. Results: Alcohol and substance abuse are recognized comorbidities in both conditions. The author of this commentary has recently been the first to propose that chronic exposure to nitrous oxide (N2O), an increasing environmental air pollutant and greenhouse gas, may contribute to the cognitive impairment seen in conditions such as ADHD and autism. The toxic synergisms from combined GABA-mimetics, such as ethanol, and nontoxic N2O exposure have been previously elucidated and are further contextualized here. Conclusion: The conclusion of this commentary is that the toxicological interdependence of the underlying etiologies for mTBI and ADHD may help to explain their association as found in the meta-analysis conducted by Adeyemo et al. This commentary explores this dynamic further and, in so doing, underscores the need for additional research to validate these important conclusions.
Objective: To explore whether clinical variables and initial cognitive abilities predict or moderate (far) transfer treatment outcomes of cognitive training. Method: A total of 98 children (aged 8-12 years) with ADHD were randomly assigned to Cogmed Working Memory Training or a new cognitive training called "Paying Attention in Class." Outcome measures included neurocognitive assessment, parent and teacher rated questionnaires of executive functioning behavior and academic performance. Predictor/moderator variables included use of medication, comorbidity, subtype of ADHD, and initial verbal and visual working memory skills. Results: Parent and teacher ratings of executive functioning behavior were predicted and moderated by subtype of ADHD. Word reading accuracy was predicted by subtype of ADHD and comorbidity. Use of medication and initial verbal and visual spatial working memory skills only predicted and moderated near transfer measures. Conclusion: Cognitive training can be beneficial for certain subgroups of children with ADHD; individual differences should be taken into account in future trials.
Objective: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.
Objective: Research about Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) age of onset criterion for ADHD led to increasing that criterion to 12 in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). Although an improvement from the previous age at onset of 7, whether this new criterion is adequate to capture all cases with ADHD remains uncertain. Method: We compared three groups of adults: (a) ADHD participants who met all DSM-5 criteria for ADHD (n = 182), (b) late-onset ADHD participants who met all criteria except for later age at onset (n = 17), and (c) non-ADHD participants who did not meet criteria for ADHD (n = 117). We assessed patterns of symptoms, psychiatric comorbidity, functional impairment, familial transmission, quality of life, social adjustment, and intelligence. Results: Compared with non-ADHD participants, all ADHD groups had poorer quality of life and had more impaired social adjustment. Compared with each other, the ADHD groups had similar patterns of psychiatric comorbidity, functional impairment, familial transmission, and intelligence. Conclusion: When assessing adult ADHD, self-reported onsets of ADHD after 12 years of age may be warranted.
Objective: Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. Method: We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. Results: Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. Conclusion: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.
Objective: To analyze the diagnostic effectiveness of the AULA Nesplora test to discriminate the different ADHD presentations: impulsive/hyperactive (I/H), inattentive, and combined.Method: A total of 117 students (76.9% male and 23.1% female) between 5 and 16 years of age (M = 11.18 years, SD = 3.10 years) participated, and were divided into three groups with ADHD according to their presentation, and a control group. Results: Each of the test conditions allowed the discrimination between the I/H and combined presentations with respect to the control group, and between the I/H and inattentive presentations. However, differences among ADHD presentations were only evident when the results were separately analyzed for the visual and auditory modalities. Conclusion: This study showed that the indicators offered by the AULA Nesplora test (omissions, commissions, response times, and motor activity) make it possible to establish a differential diagnosis of ADHD presentations when analyzed under different contextual conditions.
Objective: The inability to filter sensory input correctly may impair higher cognitive function in ADHD. However, this relationship remains largely elusive. The objectives of the present study is to investigate the relationship between sensory input processing and cognitive function in adult patients with ADHD. Method: This study investigated the relationship between deficit in sensory gating capacity (P50 amplitude changes in a double-click conditioning-testing paradigm and perceptual abnormalities related to sensory gating deficit with the Sensory Gating Inventory [SGI]) and attentional and executive function (P300 amplitude in an oddball paradigm and attentional and executive performances with a neuropsychological test) in 24 adult patients with ADHD. Results: The lower the sensory gating capacity of the brain and the higher the distractibility related to sensory gating inability that the patients reported, the lower the P300 amplitude. Conclusion: The capacity of the brain to gate the response to irrelevant incoming sensory input may be a fundamental protective mechanism that prevents the flooding of higher brain structures with irrelevant information in adult patients with ADHD.
Objective: This study investigated whether self-reported ADHD symptoms fluctuate substantially within adolescents from day to day, and examined the underlying symptom factor structure on a within- and between-person level. Method: Adolescents (N = 166) rated their ADHD symptoms over the phone on eight consecutive evenings (total ratings: n = 1,264). Results: ADHD symptoms showed substantial fluctuations within adolescents from day to day, as indicated by within-person standard deviations and intraclass correlation coefficients. Both a two-level factor model with three correlated factors (inattention, hyperactivity, impulsivity) and a two-level bifactor model with a general ADHD symptom factor and a specific inattention factor provided acceptable to good accounts of the structure underlying daily ADHD symptom ratings on the between- and the within-person level. Conclusion: The study demonstrates that adolescents’ ADHD symptoms fluctuate from day to day and highlights the need for intensive diagnostic processes with repeated symptom assessments and interventions that address symptom fluctuations.
Objective: An increasing number of studies suggest possible beneficial effects of exercise in alleviating ADHD functional outcomes. The current study provides a quantitative meta-analysis of the available studies investigating this relationship. Method: Studies reporting on the effects of physical exercise on motor skills and executive functions in children with ADHD were identified through Cochrane, PsycInfo, PubMed, Web of Science databases. Ten publications were selected. Random-effects model was used to calculate effect sizes. Results: There was a significant effect of exercise on ADHD functional outcomes (g = 0.627). Longer exercise intervention duration was consistently associated with larger effect sizes. Effect sizes were not related to exercise intensity, mean age of participants, or gender distribution. Conclusion: Results suggest that exercise has a modest positive impact on ADHD functional outcomes, such as executive functions and motor skills, with longer interventions yielding better results.
Objective: Measurement reliability is assumed when executive function (EF) tasks are used to compare groups or to examine relationships between cognition and etiologic and maintaining factors of psychiatric disorders. However, the test–retest reliabilities of many commonly used EF tasks have rarely been examined in young children. Furthermore, measurement invariance between typically developing and psychiatric populations has not been examined. Method: Test–retest reliability of a battery of commonly used EF tasks was assessed in a group of children between the ages of 5 and 6 years old with (n = 63) and without (n = 44) ADHD. Results: Few individual tasks achieved adequate reliability. However, confirmatory factor analysis (CFA) models identified two factors, working memory and inhibition, with test–retest correlations approaching 1.0. Multiple indicators multiple causes (MIMIC) models confirmed configural measurement invariance between the groups. Conclusion: Problems created by poor reliability, including reduced power to detect group differences, index change over time, or to identify relationships with other measures, may be mitigated using latent variable approaches.
Objective: This study aimed to investigate the relationship between polyunsaturated fatty acids (PUFAs) status, cognitive, and behavioral traits of ADHD in school-aged children. Method: Seventy-three children with and without ADHD were assessed with cognitive tasks and behavioral rating scales including quality of life and global functioning at baseline of an intervention trial (clinicaltrials.gov NCT01796262). Correlation analyses were performed between the cognitive tasks/behavioral ratings and blood PUFA levels. Results: Children with ADHD had lower levels of DHA, omega-3 index, and total PUFA. PUFAs were positively associated with behavior but not consistently related to cognitive domains. Conclusion: The present study confirms that children with ADHD display abnormal fatty acid profiles within an Italian setting. Furthermore, PUFAs were associated with behavior but not with cognition. Accordingly, for the first time, lower blood levels of PUFA were associated not only with symptoms of ADHD but also with a poorer quality of life.
Objective: Emotional lability (EL) and oppositional defiant disorder (ODD) frequently co-occur with ADHD. This study evaluates whether EL merely represents the negative "mood/affect" component of ODD or forms a distinct dimension. Method: EL and ODD data from 1,317 ADHD participants were analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for binary data. Results: Within ADHD, 39.4% children had ODD and 42.6% had EL. A sizable proportion expressed only either ODD or EL: 16.6% had ODD-only, 19.7% had EL-only, and 22.9% expressed both. In both EFA and CFA, EL forms a separate dimension from ODD items and the "mood/affect" subdimensions (whether classified by Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5] or the Burke et al. models or the de novo ODD subdimensions derived from our data). This factorial structure remains invariant across gender. Conclusion: EL is distinct from ODD and its "mood/affect" subdimensions. In line with emerging evidence, our findings provide further evidence of factorial validity for EL as a separate construct from ODD.
Objective: Characterized by significant work-related impairments, difficulties with relationships, and higher rates of criminal behavior and substance abuse, ADHD is now understood as a disability that can persist throughout a lifetime. Differing opinions remain, however, regarding adult symptoms of ADHD, particularly with regard to gender differences. These issues add to the challenges of constructing a reliable and valid measure of ADHD for use with adults in research and practice. Method: We review the theoretical foundations of ADHD and psychometric properties of a major assessment device, the Conners’ Adult ADHD Rating Scales (CAARS). Results: Results of the literature review found (a) a wide range of internal consistency estimates, with lowest values for the Diagnostic and Statistical Manual of Mental Disorders (DSM)–Hyperactive/Impulsive Symptoms subscale when completed by women, and (b) discriminant validity estimates in the same range as convergent validity estimates. Conclusion: These findings raise questions about the construct validity of the CAARS and suggest directions for future research.
Objective: The objective was to obtain normalized data from the ADHD Rating Scale–IV–Preschool Version (ADHD-RS-IV-P) in a Spanish sample. Method: We translated and adapted the ADHD-RS-IV to our culture to obtain normalized data from a random representative sample of 1,426 Spanish preschool children (3 to <7 years old; 49.7% males). To analyze differences between evaluators, we used MANOVA. Internal consistency was assessed via Cronbach’s alpha. Results: The mean age was 4.7 years old. There was a significant sex effect. The questionnaire had an internal consistency between .86 and .96 according to subscale and evaluator. Conclusion: To evaluate ADHD in preschool children, it is necessary to use scores standardized by sex. Using a validated scale in schools and primary care centers may be useful for early detection of ADHD.
Objective: Mindfulness-based therapies (MBTs) have been shown to be efficacious in treating internally focused psychological disorders (e.g., depression); however, it is still unclear whether MBTs provide improved functioning and symptom relief for individuals with externalizing disorders, including ADHD. To clarify the literature on the effectiveness of MBTs in treating ADHD and to guide future research, an effect-size analysis was conducted. Method: A systematic review of studies published in PsycINFO, PubMed, and Google Scholar was completed from the earliest available date until December 2014. Results: A total of 10 studies were included in the analysis of inattention and the overall effect size was d = –.66. A total of nine studies were included in the analysis of hyperactivity/impulsivity and the overall effect was calculated at d = –.53. Conclusion: Results of this study highlight the possible benefits of MBTs in reducing symptoms of ADHD.
Objective: Psychoeducation forms part of the current practice for ADHD; however, its efficacy is yet to be established. Method: Sixty-nine children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation program (n = 35), or belong to a control group (treatment-as-usual, n = 34). Results: One-way analyses of variance showed a statistically significant Treatment x Time interaction, for ADHD total symptoms, inattention/cognition, and hyperactivity/impulsivity subdomains according to the parents, the first two with medium-large effect sizes. The effects of the intervention on the ADHD total and the inattention/cognition domain persisted after 6 months follow-up. No significant differences in teacher ratings were found; however, an improvement in clinical functioning as measured by clinicians was observed. Conclusion: This psychoeducation program has shown effectiveness in reducing ADHD symptoms when compared with treatment as usual. Psychoeducation needs to be considered as a valid and additional approach in ADHD.
Objective: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD). Method: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data. Results: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]). Conclusion: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.
Objective: At present, there are inconsistencies in the literature pertaining to the association between ADHD and problem gambling. This study utilized meta-analytic techniques to clarify the association between symptoms of problem gambling and symptoms of ADHD. Method: Several meta-analyses were conducted using a random effects model. PsycINFO, PubMed, ProQuest Dissertations & Theses, and Google Scholar were searched for relevant studies. Results: The weighted mean correlation between ADHD symptomology and gambling severity was r = .17, 95% confidence interval (CI) = [0.12, 0.22], p < .001. Mean age of the sample was the only moderator to approach significance, with greater age being linked to a stronger relationship between symptoms of ADHD and gambling severity. Conclusion: Clinicians needs to be cognizant of the greater risk of ADHD symptoms when working with problem gamblers and vice versa.
Objective: This article tries to answer the question whether or not there is evidence for a relationship between celiac disease (CD) and ADHD. A review of the current literature on this topic is provided. Method: PUBMED/MEDLINE, Web of Science, and Google scholar were searched to include all published trials on ADHD and CD (no date limitation, both noncontrolled and controlled trials). In addition, the reference list of included studies was screened to find other relevant articles. Results: Eight studies report a possible association between CD and ADHD; however, the results are inconsistent. Only three out of eight studies report a positive correlation between ADHD and CD. Conclusion: Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement gluten-free diet as a standard treatment in ADHD.
Objective: This study tested a novel feed-forward modeling (FFM) system as a nonpharmacological intervention for the treatment of ADHD children and the training of cognitive skills that improve academic performance. Method: This study implemented a randomized, controlled, parallel design comparing this FFM with a nonpharmacological community care intervention. Improvements were measured on parent- and clinician-rated scales of ADHD symptomatology and on academic performance tests completed by the participant. Participants were followed for 3 months after training. Results: Participants in the FFM training group showed significant improvements in ADHD symptomatology and academic performance, while the control group did not. Improvements from FFM were sustained 3 months later. Conclusion: The FFM appeared to be an effective intervention for the treatment of ADHD and improving academic performance. This FFM training intervention shows promise as a first-line treatment for ADHD while improving academic performance.
Objective: This study compared practitioner self-report of ADHD quality of care measures with actual performance, as documented by chart review. Method: In total, 188 practitioners from 50 pediatric practices completed questionnaires in which they self-reported estimates of ADHD quality of care indicators. A total of 1,599 charts were reviewed. Results: The percentage of patients for whom practitioners self-reported that they used evidence-based care was higher in every performance category when compared with chart review, including higher use of parent and teacher rating scales during assessment and treatment compared with chart review. Self-reported use of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria during assessment was also higher than by chart review. The actual number of days until the first contact after starting medication was nearly three times longer than self-report estimates. Conclusion: Practitioners overreport performance on quality of care indicators. These differences were large and consistent across ADHD diagnostic and treatment monitoring practices. Practitioner self-report of ADHD guideline adherence should not be considered a valid measure of performance.
Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.
Objective: The ADHD–obesity link has been suggested to result from a shared underlying basis of suboptimal dopamine (DA); however, this theory conflicts evidence that an amplified DA signal increases the risk for overeating and weight gain. A model was tested in which ADHD symptoms, predicted by hypodopaminergic functioning in the prefrontal cortex, in combination with an enhanced appetitive drive, predict hedonic eating and, in turn, higher body mass index (BMI). Method: DRD2 and DRD4 markers were genotyped. The model was tested using structural equation modeling in a nonclinical sample (N = 421 adults). Results: The model was a good fit to the data. Controlling for education, all parameter estimates were significant, except for the DRD4-ADHD symptom pathway. The significant indirect effect indicates that overeating mediated the ADHD symptoms–BMI association. Conclusion: Results support the hypothesis that overeating and elevated DA in the ventral striatum—representative of a greater reward response—contribute to the ADHD symptom–obesity relationship.
Objective: No systematic reviews could be identified in the literature that address ADHD research in Arab countries. In an attempt to help fill this gap, this systematic review was undertaken. Method: An electronic literature search of ADHD studies carried out in Arab countries was done by using Google Scholar, PsycINFO, PubMed, Education Resources Information Center (ERIC), and Arabpsynet. Results: The search yielded 58 studies (10 studies on psychoeducational and social aspects of ADHD, 26 prevalence studies and two reviews of epidemiology of ADHD, and 22 studies on risk factors and comorbidities in ADHD). Conclusion: Although there has been an increase in ADHD research in Arab countries in recent years, this research remains relatively sparse and used methods and procedures that limit the generalizability of the findings.
Objective: To investigate the relationship of static reversals, handedness and gender to reaction time variability (RTV) in a sequentional sample of 1,109 children referred to a child psychiatry clinic for investigation of possible ADHD. Method: A DSM-III ADHD diagnosis and ADHD severity ratings (mild, moderate, and severe) by the present investigator was recorded. The age at which the children were still manifesting static reversals as reported by their mother, and right, left, or both-handedness as reported by the mother and observed by the investigator, were noted. Results: The age that letter reversals were still manifested was significantly associated with RTV for male and female children. Conclusions: The findings may represent an early manifestation of a failure of suppression of visually symmetrical information and/or a failure of default mode suppression
Objective: Clinicians frequently rely upon the results of self-report rating scales when making the diagnosis of ADHD; however, little research exists regarding the ability of self-report measures to accurately differentiate ADHD from other disorders. Method: This present study investigated the ability of the Conners’ Adult ADHD Rating Scale (CAARS) to discriminate between 249 postsecondary students with carefully diagnosed ADHD and 507 clinical controls. Results: The overall discriminant validity of the CAARS was 69%, and it had an unacceptably high false positive and false negative rate. At lower prevalence rates, a high score on the CAARS has only a 22% chance of accurately identifying individuals with ADHD. Conclusion: Although the CAARS is an adequate screening measure, it should not be the main method by which a diagnosis is made, as it frequently misidentifies individuals with other psychological complaints as having ADHD. Implications for clinical practice are discussed.
Objective: This study is aimed to investigate neuropsychological deficits in adult ADHD. Method: Neuropsychological deficits in terms of executive functions, divided, selective, and sustained attention, were investigated in a group of adults with ADHD using a series of neuropsychological tests as well as electroencephalography (EEG). Subjective ratings of everyday life attention and memory problems were also collected. Results: Adults with ADHD showed impairments in executive functions, divided attention and sustained attention, compared with adult controls. Performance on selective attention tasks in adults with ADHD was instead no different from control participants’ performance. EEG results confirmed neuropsychological findings by showing a selective impairment on P3 event-related potential (ERP) amplitude indicative of sustained attention deficits. Higher subjective ratings of everyday attentional and memory problems were also found in the ADHD group compared with the control group. Conclusion: This pattern of results suggests differential impairments of attentional skills. Impaired executive functions and higher subjective functional impairments were also found.
Objective: The present study investigated structural brain differences between adolescents with ADHD and matched control participants. Method: Voxel-based morphometry (VBM) using the DARTEL approach was performed to assess regional gray matter (GM) volumes. Additionally, individual performance on tests of attention was recorded to correlate ADHD related cognitive impairments with regional gray matter abnormalities. Results: We found significantly smaller GM volume in subjects with ADHD compared to their matched controls within the anterior cingulate cortex (ACC), the occipital cortex, bilateral hippocampus/amygdala and in widespread cerebellar regions. Further, reductions of the ACC gray matter volume were found to correlate with scores of selective inattention. Conclusion: These findings underline that structural alterations in a widespread cortico-subcortical network seem to underlie the observable attention problems in patients with ADHD.
Objective: Higher rates of conflict are observed between adolescents with ADHD and their parents due to cognitive, academic, social, and behavioral difficulties. Conflict should be even more pronounced when parents have ADHD themselves; however, some research suggests that parents with ADHD may have increased tolerance toward children who share similar challenges (i.e., similarity-fit hypothesis). Method: We tested the similarity-fit model and its converse, the similarity-misfit model, in a sample of 93 ADHD adolescents, 63 comparison adolescents, and their parents with varying levels of ADHD. Quantity and intensity of conflict were examined in mothers and fathers separately. Results: We found evidence for the similarity-fit process in fathers, and similarity misfit in mothers, particularly regarding quantity of conflict between parent and adolescent. Conclusion: Results indicate the importance of differential parental roles in mothers and fathers, and have implications for involving parents in treatment for ADHD in adolescents.
Objective: This study aims to develop an age-adjusted Child Behavior Checklist- (CBCL) and Teacher Report Form (TRF)-based method for the detection of deficient emotional self-regulation (DESR) in preschoolers with ADHD and to assess its incidence, comorbidities, and consequences on interpersonal functioning. Method: Eighty-six ADHD preschoolers and 104 controls were assessed using CBCL, TRF/11/2 to 5, Psychiatric Interview With Preschool Age Psychiatric Assessment, Leiter-R, and ADHD rating scales. Results: Greatest sensitivity and specificity were obtained applying slightly lower threshold scores compared with school-age children (CBCL: Anxiety/Depression [A/D] ≥ 59, Attention Problems [AP] ≥ 60, Aggression Behaviors [AB] ≥ 58; TRF: A/D ≥ 59, AP ≥ 60, AB ≥ 60). DESR was detected in 33/86 (38.4%) and in 16/54 (29.6%) ADHD preschoolers versus 2/104 (1.9%) controls using CBCL and TRF, respectively. DESR is associated with significantly greater comorbidity and impairment in interpersonal functioning. Conclusion: Among ADHD preschoolers, DESR (a) requires lower CBCL and TRF threshold scores for detection, compared with school-age children, (b) displays similar incidence rates, and (c) is associated with enhanced psychiatric comorbidity and interpersonal difficulties.
Objective: ADHD is a chronic neurodevelopmental disorder that typically results in persistent academic difficulties over time. Although most colleges offer support services, students often do not use the available services or those to which they are entitled. The present study examined predictors of academic performance among college students with and without ADHD. In addition, the rate, predictors, and outcomes of academic service use were explored. Methods: A series of multivariate analyses of variance (MANOVAs) and regression analyses were conducted using SPSS v. 21 ® software. Results: First year college students with ADHD earned significantly lower grade point averages (GPAs) relative to students without ADHD. Additionally, ADHD combined with other disorders, but not ADHD alone, predicted higher rates of service use relative to students without ADHD. Finally, the findings suggest that typically available academic services are not independently related to GPA among first-year college students with or without ADHD. Conclusion: This study replicates previous work demonstrating significantly lower GPAs among a rigorously defined sample of students with ADHD relative to students without ADHD. Second, this study indicates that traditional predictors of college success may be less meaningful for students with ADHD relative to those without ADHD. Finally, additional research needs to be conducted regarding the use and effectiveness of academic services on college campuses.
Objective: Fetal alcohol spectrum disorders (FASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. Method: The present meta-analysis was undertaken to disentangle the behavioral phenotype of FASD and ADHD by quantitatively differentiating executive functioning differences between these two groups. The current meta-analysis reviews 15 studies comparing children and adolescents with FASD and ADHD to typically developing (TD) samples, on a variety of executive function measures. Results: Results indicate that when compared with TD samples, FASD and ADHD samples demonstrate significant executive function deficits (d = 0.82 and d = 0.55, respectively). In addition, FASD samples experience significantly greater deficits when compared with ADHD samples (d = 0.25). Results were moderated by IQ and socioeconomic status. Conclusion: These findings further our understanding of the cognitive differences between FASD and ADHD samples and have the potential to influence future basic research, assessment, and intervention.
Objective: We compared Child Behavior Checklist (CBCL)-AAA (Attention Problems, Aggressive Behavior, and Anxious/Depressed) and Parent–Young Mania Rating Scale (P-YMRS) profiles in Brazilian children with ADHD, pediatric-onset bipolar disorder (PBD), and PBD + ADHD. Method: Following analyses of variance or Kruskal–Wallis tests with multiple-comparison Least Significant Difference (LSD) or Dunn’s Tests, thresholds were determined by Mann–Whitney U Tests and receiver operating characteristic (ROC) plots. Results: Relative to ADHD, PBD and PBD + ADHD groups scored higher on the Anxious/Depressed, Thought Problems, Rule-Breaking, and Aggressive Behavior subscales and Conduct/Delinquency Diagnostic Scale of the CBCL; all three had similar attention problems. The PBD and PBD + ADHD groups scored higher than the ADHD and healthy control (HC) groups on all CBCL problem scales. The AAA-profile ROC had good diagnostic prediction of PBD + ADHD. PBD and PBD-ADHD were associated with (similarly) elevated P-YMRS scores. Conclusion: The CBCL-PBD and P-YMRS can be used to screen for manic behavior and assist in differential diagnosis.
Objective: This study’s objective is to differentiate possible ADHD syndromes on the basis of symptom trajectories, prognosis, and associated clinical features in a high-risk cohort. Method: Latent class analysis of inattentive (IA) and hyperactive–impulsive (HI) symptoms in 387 non-disabled members of a regional low birthweight/preterm birth cohort who were evaluated for ADHD at 6, 9, and 16 years. Adolescent functional outcomes and other clinical features were examined across the classes. Results: Three latent classes were identified: unaffected (modest IA and HI symptom prevalences at six, remitting by nine), school age limited (relatively high IA and HI symptom prevalences at six and nine, declining by 16), and persistent inattentive (high IA and HI prevalences at six and nine, with high IA levels persisting to 16). The persistent inattentive class was distinctively associated with poor functioning, motor problems, other psychiatric disorders, and social difficulties as indexed by a positive screen for autism spectrum disorder at 16. Conclusion: These findings differentiate a potential persistent inattentive syndrome relevant to ADHD evaluation and treatment.
Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Daily Parent Rating of Evening and Morning Behavior Scale, Revised (DPREMB-R) morning score as a measure of morning behaviors impaired by ADHD. Method: We used data from a clinical trial of HLD200 treatment in pediatric participants with ADHD to address our objectives. Results: The DPREMB-R morning score showed significant internal homogeneity, test–retest reliability (r = .52-.45), and good concurrent validity (r = .50-.71). Conclusion: The DPREMB-R morning score could be a useful instrument for assessing treatment efficacy in the morning before school.
Objective: To compare the rate of persistence of ADHD into adulthood as determined by a norm-referenced versus non-norm-referenced diagnostic interview, and by standardized questionnaires. Method: Adults from a birth cohort, including research-identified childhood ADHD cases (N = 232; Mage = 27.0 years; 167 males, 65 females) and controls (N = 335; Mage = 28.6 years; 210 males, 125 females), were administered the M.I.N.I. International Neuropsychiatric Interview, the Murphy–Barkley Symptoms Checklist (MB), and the Wender Utah Rating Scale (WURS) Results: Among the childhood ADHD cases, 29.3% fulfilled criteria for adult ADHD using a norm-referenced approach to M.I.N.I. scoring, versus 13.8% using published M.I.N.I. criteria. Among participants meeting norm-referenced diagnostic criteria, 41.8% and 69.1% were classified as adult ADHD using the MB and WURS, respectively. Conclusion: A non-norm-referenced approach resulted in a significant underestimate of the rate of adult ADHD. Reliance on either of two adult ADHD questionnaires would have further reduced this estimate.
Objective: To determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drug Dependence Systems, Western Australian Literacy and Numeracy Assessment database, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: Twenty-three percent of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident in reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.
Objective: The purpose of this study was to improve the inhibitory control functions through transcranial direct current stimulation (tDCS) in adolescents with ADHD symptoms. Method: Twenty high school students with ADHD symptoms participated in this single-blinded, crossover, sham-controlled study. All the participants were tested during the application of Stroop and Go/No-Go tasks that is used to measure inhibitory control, using 1.5 mA of tDCS for 15 min over the left dorsolateral prefrontal cortex (DLPFC). Results: Anodal stimulation on left DLPFC had no effect on interference inhibition during the Stroop task and increased the proportion of correct responses in the "Go stage" of the Go/No-Go test compared with sham condition. Cathodal stimulation on the left DLPFC increased the inhibition accuracy in the inhibition stage during Go/No-Go task in comparison with sham. Conclusion: tDCS over the left DLPFC of adolescents who suffer from ADHD symptoms can improve inhibitory control in prepotent response inhibition.
Objective: Adult ADHD has dramatic impacts on various aspects of life and relationships. This study investigates how "gender roles" mediate the effects of ADHD on marriage. Method: Sixty-two heterosexual couples were included in the study. The Marital Impact Checklist is used to assess the effects of ADHD on marriage. The Gender Roles Attitude Scale is used to measure gender roles in both the patient and the spouse. Results: The Turkish version of the Marital Impact Checklist is found to have good internal consistency and utility in research and clinical work with ADHD couples. The female non-ADHD partners reported feeling of "Unloved" and "Negative Impact" more than their male counterparts. Some subdomains of the gender roles of both the patient and their non-ADHD spouse seem to mediate the effect of adult ADHD’s impact on marriage. Conclusion: Sex and gender roles diversify how ADHD affects marriage.
Objective: The objective of this study is to investigate the discriminative validity of neuropsychological tests and diagnostic assessment instruments in diagnosing adult ADHD in a clinical psychiatric population. Method: Of 108 patients, 60 were diagnosed with ADHD. The Diagnostic Interview for ADHD in adults (DIVA 2.0) and Adult ADHD Self-Report Scale (ASRS) v.1.1 together with eight neuropsychological tests were investigated. Results: All instruments showed poor discriminative ability except for the DIVA, which showed a relatively good ability to discriminate between the groups (sensitivity = 90.0; specificity = 72.9). A logistic regression analysis model with the DIVA and measures of inattention, impulsivity, and activity from continuous performance tests (CPTs) showed a sensitivity of 90.0 and a specificity of 83.3. Conclusion: Neuropsychological tests have a poor ability to discriminate between patients diagnosed with ADHD and patients not diagnosed with ADHD, but variables from CPT tests can contribute to increasing the specificity by 10% if used in combination with the DIVA.
Objective: Examine the influence of maternal and child race on ADHD symptom ratings. Method: Participants were Black (n = 63) and White (n = 68) mothers randomly assigned to view a 13-min videotape of either a Black or White boy displaying similar levels of ADHD-related behaviors during free play and meal situations. Mothers then completed an ADHD rating scale. Results: With maternal age and socioeconomic status (SES) as covariates, Black mothers provided significantly higher ratings of inattentive and hyperactive–impulsive symptoms than did White mothers regardless of child race. The effect of child race was not statistically significant. Conclusions: Maternal race appears to be more important than child race in accounting for differences in ADHD symptom ratings between Black and White boys. It is critical to understand variables related to these differences and develop assessment measures that lead to equivalent, accurate diagnostic decisions across racial subgroups.
Objective: The objective of this article is to examine the associations between pre- and postnatal maternal distress and preschooler’s symptoms of ADHD, Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and anxiety, by timing and gender. Method: Children, aged 3.5 years (N = 1,195), recruited from the Norwegian Mother and Child Cohort Study, were assessed with a semistructured parental psychiatric interview. Perinatal maternal symptoms of distress were assessed by Symptom Checklist (SCL-5); Poisson regression was used to examine the associations. Results: Mid-gestational maternal distress significantly increased the average number of child symptoms, ranging between 3.8% for ADHD hyperactive–impulsive (ADHD-HI) and 8.7% for anxiety. The combination of high maternal scores of distress both pre- and postnatally were associated with increased risk of child symptoms of anxiety (relative risk [RR] = 2.10; 95% confidence interval [CI] = [1.43, 3.07]), CD (RR = 1.83; 95% CI = [1.33, 2.51]), and ODD (RR = 1.30; 95% CI = [1.03, 1.64]), with minor sex differences. Conclusion: Maternal distress during mid-gestation was associated with ADHD, behavioral, and emotional symptoms in preschool children. Continued exposure into the postnatal period may further increase these risk associations .
Objective: This study (a) compared behavioral sleep problems in children with comorbid ADHD and autism spectrum disorder (ASD) with those with ADHD and (b) examined child/family factors associated with sleep problems. Method: Cross-sectional study comparison of 392 children with a confirmed ADHD diagnosis (ADHD+ASD, n=93, ADHD, n=299) recruited from 21 peadiatric practises in Victoria, Australia. Data were collected from parents. Key measures included the Child Sleep Habits Questionnaire (CSHQ). Results: Children with ADHD + ASD experienced similar levels and types of behavioral sleep problems compared with those with ADHD. In both groups, the presence of co-occurring internalizing and externalizing comorbidities was associated with sleep problems. Sleep problems were also associated with parent age in the ADHD + ASD group and poorer parent mental health in the ADHD group. Conclusion: Findings suggest comorbid ASD is not associated with increased behavioral sleep problems in children with ADHD and that co-occurring internalizing and externalizing comorbidities may flag children in these groups with sleep problems.
Objective: The primary aim of this study was to evaluate longitudinal pathways to impairment as outlined in the cognitive-behavioral model of ADHD in a sample of 59 college students diagnosed with ADHD. Method: Serial mediation models were used to test whether underachievement, defined as prior year GPA, would longitudinally predict self-reported impairment at the end of the next school year, through negative self-concept and associated changes in symptoms of anxiety and depression, while controlling for baseline impairment and changes in ADHD symptoms. Results: Findings supported the cognitive-behavioral model of ADHD. The association between prior year GPA and overall impairment at the end of the year was fully mediated through self-concept and symptoms of depression. Conclusion: These results help explain why impairment often persists even when ADHD symptoms remit and suggests that internalizing symptoms may be an important target for intervention in college students with ADHD.
Objective: Youth with ADHD exhibit positive bias, an overestimation of ability, relative to external indicators. The positive bias construct is understudied in adolescents, particularly in the domain of driving. Study is needed as youth with ADHD experience greater negative outcomes in driving relative to typically developing teens. Method: Positive bias on a driving simulator task was investigated with 172 teenagers with ADHD, combined type. Youth participated in a driving simulation task and rated driving performance afterward. Results: Compared with external ratings of driving performance, youth overestimated driving competence for specific driving behaviors as well as globally. The global rating demonstrated a greater degree of positive bias. Greater positive bias on global ratings of driving ability also predicted greater rates of risky driving behaviors during the simulator exercise independent from disruptive behavior disorder symptoms. Conclusion: Results inform prevention and intervention efforts for teenage drivers with ADHD.
Objective. Information foraging is atypical in both autism spectrum disorders (ASDs) and ADHD; however, while ASD is associated with restricted exploration and preference for sameness, ADHD is characterized by hyperactivity and increased novelty seeking. Here, we ask whether similar biases are present in visual foraging in younger siblings of children with a diagnosis of ASD with or without additional high levels of hyperactivity and inattention. Method. Fifty-four low-risk controls (LR) and 50 high-risk siblings (HR) took part in an eye-tracking study at 8 and 14 months and at 3 years of age. Results. At 8 months, siblings of children with ASD and low levels of hyperactivity/inattention (HR/ASD-HI) were more likely to return to previously visited areas in the visual scene than were LR and siblings of children with ASD and high levels of hyperactivity/inattention (HR/ASD+HI). Conclusion. We show that visual foraging is atypical in infants at-risk for ASD. We also reveal a paradoxical effect, in that additional family risk for ADHD core symptoms mitigates the effect of ASD risk on visual information foraging.
Objective: Our aim in this study is to evaluate the impacts of inattentive and combined types of childhood ADHD (ADHD-I, ADHD-C) in patients with social anxiety disorder (SAD). Methods: A total of 142 adult outpatients with a primary diagnosis of SAD were included. All patients were assessed by using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL), ADHD module and a clinical and sociodemographic data form and scales were filled out. Results: Childhood ADHD comorbidity rates was found to be 88 (62%) in patients with SAD, and 63 of these patients had the diagnosis of ADHD-I. ADHD-I group had higher scores of social anxiety and avoidance and had earlier onset of SAD than the ADHD-C group. Conclusion: The inattentive subtype of ADHD may have a more specific relationship with SAD than ADHD-C.
Objective: To examine the association of personality traits and characteristics on quality of life and functioning in adults with ADHD. Method: Participants were adults with (n = 206) and without ADHD (n = 123) who completed the Temperament and Character Inventory (TCI), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and the Social Adjustment Scale–Self-Report (SAS-SR). Participants also provided information on academic, motor vehicle operation, legal, social, familial, and occupational functioning. Outcomes were examined using stepwise linear regression, logistic regression (for binary outcomes), and negative binomial regression (for count outcomes) controlling for ADHD symptoms, psychiatric comorbidity, and executive dysfunction. Results: Adults with ADHD significantly differed from controls across nearly all TCI personality domains. On average, adults with ADHD endorsed more novelty seeking, harm avoidance, and self-transcendence, and less reward dependence, persistence, self-directedness, and cooperativeness. Personality traits and characteristics, especially self-directedness, significantly predicted functional impairments even after controlling for ADHD symptoms, executive function deficits, and current psychiatric comorbidities. Conclusion: In adults with ADHD, personality traits exert unique associations on quality of life and functional impairment across major life domains, beyond the relations expected of and associated with ADHD symptoms and other associated psychiatric conditions and cognitive vulnerabilities. Addressing personality traits in adults with ADHD may lead to improvements in quality of life and reductions in functional impairment.
Objective: Investigate the prevalence and impact of psychiatric comorbidities in community-based samples of schoolchildren with/without ADHD. Method: Teachers and parents screened children in South Carolina (SC; n = 4,604) and Oklahoma (OK; n = 12,626) for ADHD. Parents of high-screen and selected low-screen children received diagnostic interviews (SC: n = 479; OK: n = 577). Results: Psychiatric disorders were increased among children with ADHD and were associated with low academic performance. Conduct disorder/oppositional defiant disorder (CD/ODD) were associated with grade retention (ODD/CD + ADHD: odds ratio [OR] = 3.0; confidence interval [CI] = [1.5, 5.9]; ODD/CD without ADHD: OR = 4.0; CI = [1.7, 9.7]). School discipline/police involvement was associated with ADHD alone (OR = 3.2; CI = [1.5, 6.8]), ADHD + CD/ODD (OR = 14.1, CI = [7.3, 27.1]), ADHD + anxiety/depression (OR = 4.8, CI = [1.6, 14.8]), and CD/ODD alone (OR = 2.8, CI = [1.2, 6.4]). Children with ADHD + anxiety/depression had tenfold risk for poor academic performance (OR = 10.8; CI = [2.4, 49.1]) compared to children with ADHD alone. This should be interpreted with caution due to the wide confidence interval. Conclusion: Most children with ADHD have psychiatric comorbidities, which worsens functional outcomes. The pattern of outcomes varies by type of comorbidity.
Objective: Adolescents’ leisure activities are increasingly focusing on Internet activities, and today, these coexist with traditional leisure activities such as sport and meeting friends. The purpose of the present study was to investigate leisure activities, particularly Internet activities, among boys and girls with ADHD, and compare these with boys and girls from the general population. The objective was also to explore how traditional leisure activities and Internet activities interrelate among adolescents with ADHD. Method: Adolescents with ADHD (n = 102) were compared with adolescents from the general population on leisure activities and Internet use. Results: Leisure activities among adolescents with ADHD tended to focus on Internet activities, particularly online games. Internet activities were broadening leisure activities among adolescents with ADHD, rather than being a substitute for traditional leisure activities. Conclusion: Internet activities may provide adolescents with ADHD accessible means of social interaction.
Objective: To describe the incidence and distribution of ADHD within the United Kingdom, and to examine whether there was any association between ADHD incidence and socioeconomic deprivation. Method: The study used data from the Clinical Practice Research Datalink (CPRD). Patients diagnosed with ADHD before the age of 19 between January 1, 2004 and December 31, 2013 were stratified according to the region in which their general practice was based. Practice Index of Multiple Deprivation (IMD) score was used as a surrogate measure of patients’ deprivation status. Results: ADHD incidence was relatively stable between 2004 and 2013, but peaked in the last 2 years studied. Statistically significant (p ≤ .05) differences in incidence were observed between U.K. regions. In almost every year studied, incidence rates were highest among the most deprived patients and lowest among the least deprived patients. Conclusion: In the United Kingdom, ADHD may be associated with socioeconomic deprivation.
Objective: The aim of this study was to examine the effectiveness of mindfulness as a treatment for adults diagnosed with ADHD. A 12-week-adapted mindfulness-based cognitive therapy (MBCT) program is compared with a waiting list (WL) group. Method: Adults with ADHD were randomly allocated to MBCT (n = 55) or waitlist (n = 48). Outcome measures included investigator-rated ADHD symptoms (primary), self-reported ADHD symptoms, executive functioning, depressive and anxiety symptoms, patient functioning, and mindfulness skills. Results: MBCT resulted in a significant reduction of ADHD symptoms, both investigator-rated and self-reported, based on per-protocol and intention-to-treat analyses. Significant improvements in executive functioning and mindfulness skills were found. Additional analyses suggested that the efficacy of MBCT in reducing ADHD symptoms and improving executive functioning is partially mediated by an increase in the mindfulness skill "Act With Awareness." No improvements were observed for depressive and anxiety symptoms, and patient functioning. Conclusion: This study provides preliminary support for the effectiveness of MBCT for adults with ADHD.
Objective: To investigate adult ADHD symptoms and satisfaction with life, with a focus on age and sex differences. Method: This study is based on parents in the Norwegian Mother and Child Cohort Study (MoBa). The Adult Self-Report Scale (ASRS-6) and Satisfaction With Life Scale (SWLS) scores were analyzed from 33,210 men and 41,983 women from young to middle adulthood. Results: Mean ASRS total score was significantly higher in men, where 5.1% scored above cutoff, compared with 2.9% in women. Factor loadings supported the two ASRS subscales: Inattention (Inatt) and Hyperactivity-Impulsivity (HyImp) in both sexes. A significant decline with age was found on HyImp, whereas Inatt scores were reasonably stable in men and u-curved in women. High ASRS scores were associated with lower SWLS, but poor satisfaction with life was found only in high-scoring women. Conclusion: Our findings suggest caution to age and sex when using the ASRS-6.
Objective: Adjusting well academically and socially has been associated with enhanced academic performance and student retention. The purpose of this study was to examine subthreshold levels of ADHD symptoms such as inattention, hyperactivity, and executive functioning as potential predictors of academic and social adjustment in a healthy sample of university students. Method: Participants were 135 undergraduate university students who completed self-report questionnaires. Results: Hierarchical regression analyses revealed that metacognition (an aspect of executive function), gender, and age were significant predictors of academic adjustment beyond hyperactivity, inattention, and depression. Depression was the only significant predictor of social adjustment. Conclusion: The BASC–College form may identify depression symptoms predictive of social adjustment, but symptoms of inattention or hyperactivity are not sufficiently sensitive to predict academic adjustment. Measures of executive function that include metacognition such as the BRIEF-A may be most promising in identifying skills predictive of academic adjustment.
Objective: Children with ADHD overestimate their own social and behavioral competence when using explicit self-report measures, a phenomenon known as Positive Illusory Bias (PIB). This study examined whether children with ADHD show PIB when self-perceptions are measured implicitly, reflecting associations that are relatively difficult to consciously control. Method: Participants were 23 children (ages 6.8-9.8) with ADHD and 55 typically developing (TD) children. Children’s explicit self-perceptions of competence were measured via self-report on the Self-Perception Profile for Children; their implicit associations were assessed using an Implicit Association Test. Parent and teacher ratings formed an adult-reported composite indicator of children’s competence, to which children’s self-perceptions were compared. Results: Children with ADHD overestimated their competence as compared with adult-informant reports on both explicit and implicit measures, whereas TD children tended to be accurate. Conclusion: Inflated self-perceptions in children with ADHD may exist on an implicit level outside of conscious awareness.
Objective: To explore how ADHD may have affected the lives of older adults who meet the diagnostic criteria of ADHD, but are unaware of their diagnosis. Our second aim was to examine whether the reported symptoms change over the life span. Method: A qualitative study was conducted. Seventeen Dutch older people (>65 years) diagnosed in this study with ADHD participated in in-depth interviews. Data were analyzed according to techniques of thematic approach. Results: Seven themes emerged from the analyses. Four themes correspond to ADHD symptoms: "being active," "being impulsive," "attention problems," and "mental restlessness." In addition, the themes "low self-esteem," "overstepping boundaries," and "feeling misunderstood" emerged. The impact of ADHD symptoms seems to have declined with age. Conclusion: ADHD has a negative impact on late life, and older adults with the disorder may benefit from treatment. Moreover, this study’s findings call for early detection and treatment of ADHD in children and adults.
Objective: This study investigated the role of perceived social support in promoting emotional well-being among children with ADHD. Specifically, it examined how children with ADHD perceive support from key individuals in their lives and the relationships between this support and aspects of emotional well-being. Main versus buffering models of social support in the context of social preference status were also explored. Method: Participants were 55 school-age children with ADHD–combined or hyperactive/impulsive (ADHD-C/HI). Parent and child ratings evaluated source-specific social support, social status, and aspects of self-concept, anxiety, and depression. Results: Children with ADHD reported lower social support than normative samples. Social support had moderate positive associations with self-concept, with source-specific differences, but was not associated with internalizing symptoms. Regression models with social preference status supported a main effect model of perceived social support. Conclusion: Social support may provide a target for resilience-based interventions among children with ADHD in promoting their self-concept and well-being.
Objective: Functional imaging studies have found reduced frontal activity, mainly in dorso/ventro-lateral regions and reduced task-related de-activation of the default mode network in childhood ADHD. Adult studies are fewer and inconclusive. We aimed to investigate the potential neural bases of executive function in ADHD adults, examining brain activity during N-back task performance, and to explore the potential corrective effects of long-term methylphenidate treatment. Method: We recruited a large adult ADHD-combined sample and a matched control group and obtained functional magnetic resonance imaging (fMRI) images during task. ADHD participants were subdivided in a group under long-term treatment with methylphenidate (washed out for the scan) and a treatment-naive group. Results: ADHD participants showed deficient de-activation of the medial prefrontal cortex during 2-back task, implying default mode network dysfunction. We found no relationship between blunted de-activation and treatment history. Conclusion: As de-activation failure in the medial frontal cortex is linked to lapses of attention, findings suggest a potential link to ADHD symptomatology.
Objective: This study explored the effect of cultural and gender differences in ADHD among Spanish, African American, Hispanic American, and European American young adults. Method: Structural equivalence between the four groups was examined by Tucker’s phi coefficient. A MANCOVA was carried out with cultural groups and gender as factors and age as covariate. Results: Structural equivalence was observed across all groups, and no differential item functioning was found. No significant effect was found for gender, although, with the exception of the Hispanic group, males scored higher than females. Furthermore, small, though significant, cultural differences were found. The lowest levels of ADHD were observed in the European American group and the highest in the Hispanic American group. ADHD symptoms, notably inattention, showed some decline with age. Conclusion: Findings extend existing data and suggest a relationship between culture and the development of ADHD, which might be mediated by parenting style.
Objective: This study examined cardiovascular safety of concomitant use of long-acting stimulants (LAS) and atypical antipsychotics (AAP) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Method: The study used 2004-2007 IMS LifeLink™ claims data involving 6- to 16-year-old children with ADHD and at least one LAS prescription from July 2004 to December 2006. Time-dependent Cox regression analysis was performed to evaluate the risk of cardiovascular disease (CVD) events due to concomitant use of LAS and AAP. Results: The analytical cohort consisted of 37,903 children: 538 (1.9%) used LAS and AAP concurrently and the rest used LAS monotherapy. Time-dependent Cox regression analysis revealed no difference in CVD risk among concomitant users of LAS and AAP (hazard ratio = 1.19; 95% confidence interval = [0.60, 2.53]) when compared with users of LAS monotherapy. Conclusion: Concomitant use of LAS and AAP was not associated with risk of CVD events in ADHD patients when compared with LAS monotherapy.
Objective: Converging evidence indicates large magnitude deficits in the "working" component of working memory for children with ADHD. However, our understanding of the relation between these central executive deficits and ADHD behavioral symptoms remains limited due to problems with several commonly used working memory tests. Method: Children with ADHD (n = 25) completed a counterbalanced series of working memory tasks that differed only in memory set predictability. Results: Results indicated that central executive demands increased when memory set was unpredictable, as evidenced by moderate performance decreases (d = 0.22-0.56) and large changes in performance variability (d = 0.93-3.16) and response times (d = 1.74-4.16). Activity level remained relatively stable when memory set was unpredictable but decreased significantly over time when memory set was predictable. Conclusion: Results suggest that altering memory set predictability is a feasible method for increasing/maintaining central executive demands over time, and suggest a positive association between working memory demands and gross motor activity for children with ADHD.
Objective: Oppositional Defiant Disorder (ODD) is highly prevalent in Attention-Deficit/Hyperactivity Disorder (ADHD) and may account for inconsistencies in findings on neurocognitive functioning in ADHD. Our aim was to assess cool and hot executive functioning (EF) and temporal processing in ADHD with and without comorbid ODD to elucidate the effects of comorbid ODD. Method: ADHD-only (n = 82), ADHD + ODD (n = 82), and controls (n = 82), with mean age 16 years (SD = 3.1), matched for age, gender, IQ, and ADHD type (clinical groups) were assessed on cool EF (inhibition, working memory), hot EF (reinforcement processing, emotion recognition), and temporal processing (time production and reproduction). Results: Individuals with ADHD + ODD showed abnormalities in inhibition, working memory, facial emotion recognition, and temporal processing, whereas individuals with ADHD-only were solely impaired in working memory and time production. Conclusion: Findings suggest that ODD carries a substantial part of the EF deficits observed in ADHD and contrast with current theories of neurocognitive impairments in ADHD.
Objective: To investigate the interaction between catechol-O-methyltransferase gene (COMT) Val108/158Met (rs4680) and season of birth (SOB) on ADHD and its symptoms. Method: We conducted transmission disequilibrium tests (TDTs) in 976 trios, then further performed the above analyses in subgroups according to SOB. Quantitative analyses were performed for ADHD symptoms evaluated by ADHD Rating Scale–IV in 1,530 ADHD cases. Results: Overall, there was no association between COMT and ADHD. After stratification, we found an increased transmission of the Val allele in the trios born in spring, while a decreased transmission was observed in the autumn months. We also observed a significant interaction between Val108/158Met and SOB on ADHD symptoms. Among those born in spring, Met carriers had milder ADHD symptoms compared with Val homozygotes, whereas opposite association was found in those born in autumn. Conclusion: Our study provided evidence for the modifying effect of SOB on the association between COMT and ADHD along with its symptoms.
Objective: Studies on comorbidity in children diagnosed with ADHD have relied more on parent/teacher reports instead of self-reported data and have focused on the frequency of comorbid symptoms instead of scores above clinical cutoffs. The purpose of this study was to examine the prevalence of oppositional defiant disorder (ODD), anxiety, and depression in children with ADHD, using self-report measures for internalizing symptoms and parent-reported measures for externalizing symptoms for increased accuracy. Gender differences were also assessed. Method: Parents of 197 children diagnosed with ADHD answered the Disruptive Behavior Rating Scale, and 112 of the children filled out the Multidimensional Anxiety Scale for Children and the Children’s Depression Inventory. Results: Results revealed that 19.28% of the children met cut-off criteria for ODD, 41.96% for anxiety, and 21.43% for depression. Conclusion: Our findings indicate a relatively lower prevalence of ODD and a slightly higher prevalence of anxiety symptoms than previously reported. Possible explanations and future directions are discussed.
Objective: ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest. Method: This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up. Results: In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety. Conclusion: Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.
Objective: Parental psychopathology and parenting quality robustly predict negative outcomes among children with ADHD. Little research has investigated associations between paternal ADHD symptoms and parenting, though there is clear evidence linking maternal ADHD symptoms with both suboptimal parenting and child conduct problems, and considerable research supporting fathers’ significant contributions to their children’s development. Method: This cross-sectional study examined psychopathology and parenting in a sample of fathers (N = 102) and their 5- to 12-year-old children with previously diagnosed ADHD. Results: Results suggested that paternal antisocial personality disorder (ASPD) symptoms (rather than ADHD symptoms) were robustly associated with child conduct problems, with an indirect effect through paternal negative parenting. Conclusion: This study suggests that negative parenting may be a potential mechanism by which paternal ASPD is associated with child conduct problems, and demonstrates the importance of considering co-occurring psychopathology in research examining adult ADHD, parenting, and child outcomes.
Objective: The present study investigated differences in emotional face processing between adolescents (age 15-18) with ADHD-Combined type (ADHD-CT) and typically developing controls. Method: Participants completed a visual emotional task in which they were asked to rate the degree of negativity/positivity of four facial expressions (taken from the NimStim face stimulus set). Results: Participants’ ratings, ratings’ variability, response times (RTs), and RTs’ variability were analyzed. Results showed a significant interaction between group and the type of presented stimuli. Adolescents with ADHD-CT discriminated less between positive and negative emotional expressions compared with those without ADHD. In addition, adolescents with ADHD-CT exhibited greater variability in their RTs and in their ratings of facial expressions when compared with controls. Conclusion: The present results lend further support to the existence of a specific deficit or alteration in the processing of emotional face stimuli among adolescents with ADHD-CT.
Objective: We aimed to provide an overview of the Massachusetts General Hospital (MGH) Longitudinal Studies of ADHD. Methods: We evaluated and followed samples of boys and girls with and without ADHD ascertained from psychiatric and pediatric sources and their families. Results: These studies documented that ADHD in both sexes is associated with high levels of persistence into adulthood, high levels of familiality with ADHD and other psychiatric disorders, a wide range of comorbid psychiatric and cognitive disorders including mood, anxiety, and substance use disorders, learning disabilities, executive function deficits, emotional dysregulation, and autistic traits as well as functional impairments. The MGH studies suggested that stimulant treatment decreased risks of developing comorbid psychiatric disorders, substance use disorders, and functional outcomes. The MGH studies documented the neural basis of persistence of ADHD using neuroimaging. Conclusion: The MGH studies provided various insights on symptoms, course, functions, comorbidities, and neuroscience of ADHD.
Objective: This exploratory study measured the impact of comorbid anxiety disorders on sleep in children with ADHD and tested the effect of cognitive-behavioral therapy (CBT) on these measures. Method: Fifty-seven children (8-12 years old) were assessed with the Child Sleep Habits Questionnaire. Four groups were formed: ADHD (n = 20), ADHD + Anxiety (n = 20), Anxiety (n = 8), and Healthy Controls (n = 9). A subgroup of 10 children with ADHD + Anxiety underwent CBT for anxiety. Results: The results showed that sleep difficulties were better associated with anxiety than with ADHD. CBT reduced sleep onset latency and marginally decreased the total amount of sleep problems. Conclusion: The present study demonstrates that comorbid anxiety in ADHD children is linked with specific sleep disturbances and is sensitive to CBT aimed at reducing anxiety.
Objective: The purpose of this study was to investigate the impact of a concurrent "white noise" stimulus on selective attention in children with ADHD. Method: Participants were 33 children aged 7 to 14 years, who had been previously diagnosed with ADHD. All children completed a computer-based conjunction search task under two noise conditions: a classroom noise condition and a classroom noise + white noise condition. The white noise stimulus was sounds of rain, administered using an iPhone application called Sleep Machine. Results: There were no overall differences between conditions for target detection accuracy, mean reaction time (RT), or reaction time variability (SD). The impact of white noise on visual search depended on children’s medication status. Conclusion: White noise may improve task engagement for non-medicated children. White noise may be beneficial for task performance when used as an adjunct to medication.
Objective: Cognitive flexibility or attentional set-shifting capacity has long been considered a core area of executive dysfunction for individuals with autism. Whether these difficulties are due to higher-level attentional difficulties associated with comorbid ADHD remains unclear. Method: The current study compared the performance of 48 participants with autism, ADHD, autism-ADHD, and a comparison group (N = 12 per group) on a set-shifting task, which included a local–global paradigm. Results: Results of this study revealed that participants with attentional difficulties (autism + ADHD and ADHD alone) exhibited a significant shifting cost (difference between maintaining and shifting attention). Conclusion: Attentional difficulties associated with ADHD may be associated with an enhanced attentional shifting cost. Implications of these results were discussed in relation to screening for ADHD symptoms in studies of individuals with autism which seek to determine the neuropsychological profile of this condition.
Objective: To characterize heterogeneity in adults with ADHD we aimed to identify subgroups within the adult ADHD spectrum, which differ in their cognitive profile. Method: Neuropsychological data from adults with ADHD (n = 133) and healthy control participants (n = 132) were used in a confirmatory factor analysis. The resulting six cognitive factors were correlated across participants to form networks. We used a community detection algorithm to cluster these networks into subgroups. Results: Both the ADHD and control group separated into three profiles that differed in cognitive performance. Profile 1 was characterized by aberrant attention and inhibition, profile 2 by increased delay discounting, and profile 3 by atypical working memory and verbal fluency. Conclusion: Our findings suggest that qualitative differences in neuropsychological performance exist in both control and ADHD adult individuals. This extends prior findings in children with and without ADHD and provides a framework to parse participants into well-defined subgroups.
Objective: To test the acceptability, satisfaction, and effectiveness of a web-based intervention for teachers of elementary school–aged children with ADHD. Method: Elementary classroom teachers (N = 58), along with their students with ADHD, participated in a randomized controlled trial. The program consisted of six sessions that included evidence-based intervention strategies for reducing ADHD symptoms and impairment in the classroom setting. Teachers also had access to a moderated Discussion Board and an online ADHD coach. Questionnaire data were electronically collected from teachers and parents pre-intervention, post-intervention (6 weeks), and after an additional 6-week follow-up. Results: Intent-to-treat analyses found significant improvements based on teacher (but not parent) reports of core ADHD symptoms and impairment for the Teacher Help for ADHD treatment group. Teachers reported a high level of acceptability and satisfaction. Conclusion: Web-based ADHD interventions have the potential to reduce the barriers to treatment utilization and implementation that are common problems for school-based ADHD interventions.
Objective: Raising a child with special needs disturbs the balance of family life and affects mothers’ everyday life. The purpose of this study was to assess the contribution of occupational competence, occupational settings, and role load to the health and life satisfaction of Arab mothers of children with and without ADHD. Method: Participants included 40 Israeli Arab women aged 25 to 40 years. Half were mothers of children with ADHD and half were mothers of children without ADHD. Data were collected by using four self-report questionnaires. Results: Occupational competence and occupational settings predicted mothers’ mental health and life satisfaction. Having or not having a child with ADHD only reflects a minor contribution. Conclusion: Enhancing mothers’ occupational competence and settings may increase their health and life satisfaction. This study highlights the need to focus on maternal occupational competence and settings as they affect mothers’ health and well-being when providing intervention to children with ADHD.
Objective: We aimed to define the sociodemographic, clinical, and prescription profiles of the participants enrolled in the Italian Lombardy ADHD Register. Method: Data on patients evaluated by the 18 regional ADHD reference centers in the 2012 to 2013 period were analyzed. Results: Seven hundred fifty-three of 1,150 (65%) suspected patients received a diagnosis of ADHD. In 24% of cases, there was a family history of ADHD. Four hundred eighty-three (64%) patients had at least one psychopathological disorder, the more common of which were learning disorders (35%). Eighty-four percent of patients received a prescription for psychoeducational interventions, 2% received only pharmacological treatment, and 14% a combination of both. Compared with patients treated with psychoeducational intervention alone, patients with drug prescriptions more commonly presented values of Clinical Global Impressions - Severity scale (CGI-S) of 5 or higher (p < .0001). Conclusion: A continuous and systematic monitoring of patterns of care is essential in promoting significant improvements in clinical practice and ensuring an efficient and homogeneous quality of care.
Objective: This work assesses family functioning, parental bonding, and the relationship between the two in adults diagnosed with ADHD. Method: The study used a retrospective, ex post facto design and consisted of 100 adult participants, who were distributed into two groups: with and without diagnosis of ADHD. Two family assessment instruments were applied: the Family Adaptability and Cohesion Evaluation Scale short spanish version (FACES-20esp)) and the Parental Bonding Instrument (PBI). The diagnosis of ADHD was done by using a semistructured interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria (Conners’ Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). Results: The results showed that higher rigidity and lower emotional connection were significantly associated with ADHD family functioning. Regarding parental bonding, the results showed significant differences only in the care dimension, with the ADHD group reporting lower care than the control group. Conclusion: The results suggest that ADHD families present dysfunctional family functioning with a rigid, separated typology, and parental bonding based on control without affection.
Objective: To identify what primary and secondary school teachers know about ADHD in children and, furthermore, to identify which factors predict their knowledge. Method: A 29-item questionnaire about ADHD was distributed to a random, nationwide, and representative sample of Danish primary and secondary school teachers. Data were analyzed descriptively and by hierarchical regression analysis. Results: A total of 528 teachers were included. Most teachers identified the symptoms of ADHD (79%-96%) and effective classroom intervention strategies (75%-98%). However, knowledge about other characteristics, etiology, prognosis, and treatment was inconsistent, for example, only 56% and 17% correctly rejected diet as a cause and effective treatment for ADHD. Among the strongest predictors for correct knowledge was having been provided postgraduate education about ADHD. Conclusion: Teachers require knowledge about ADHD to successfully include and manage children with ADHD and, additionally, to ensure positive working environments for teachers and support constructive school–home working collaborations.
Objective: Despite the limited effectiveness of ADHD medications on healthy cognition, prescription stimulants’ cognitive enhancement use is increasing. This article examines enhancement users’ attention, motivation, and study habits. Method: A total of 61 users of unprescribed stimulants and 67 controls (no history of prescription stimulant use) completed tests of objectively measured and subjectively reported attention. Self-reports on study habits, as well as motivation during laboratory attention testing, were also administered. Results: Our data replicated previous findings of relatively lower self-reported attention functioning in users. Extending past research, we showed that user-control differences in attention were still present but less pronounced on objective measures than on self-report. In addition, we obtained evidence of lower motivation during cognitive testing and less optimal study habits among users, as compared with their non-using peers. Conclusion: Unprescribed stimulant use is more strongly related to compromised study habits, low motivation, and a subjective perception of attention problems than to objective attention performance.
Objective: The aim was to determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drugs of Dependence System and Western Australian Literacy and Numeracy Assessment databases, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: A total of 23% of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident for reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.
Objective: To describe psychotropic treatment pattern and evaluate the association of socio-demographic factors and psychotropic combination therapy in children with ADHD and oppositional defiant disorder/conduct disorder (ODD/CD). Method: This is a cross-sectional drug utilization study based on Medicaid fee-for-service programs in 26 U.S. states (1999-2006). Children aged 4 to 18 with concomitant ADHD and ODD/CD were included. We calculated the prevalence of psychotropic drugs and used logistic regression to evaluate the role of socio-demographic factors in psychotropic combination therapy. Results: We identified 121,740 children with ADHD and ODD/CD (140,777 person-years). The period prevalence of "no psychotropic therapy," psychotropic monotherapy, and psychotropic dual therapy was 38.1%, 44.7%, and 9.0%, respectively. The most common drug class was stimulants. Whites, males, and children in foster care were more likely to use psychotropic combination therapy. State-level variation was observed. Conclusion: "No psychotropic therapy" and stimulants dominate treatment choices in children with ADHD and ODD/CD. Socio-demographic characteristics are associated with combination psychotropic therapy.
Objective: To estimate the prevalence of ADHD in adult patients treated for alcohol dependence and to analyze the characteristics of consumption and psychiatric comorbidity, in function of a possible ADHD in adulthood. Method: We administered the Adult ADHD Self-Report Scale (ASRS) to 726 alcohol-dependent patients. Clinical diagnosis, following Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria was made in the first four weeks of treatment. A subsample of 297 patients was evaluated using Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID-II) to test the psychometric properties of ASRS. Results: After analyzing the properties of the ASRS (sensitivity: 83.3%; specificity: 66.1%), the prevalence of ADHD, in the whole sample, was estimated to be 16.2%. Being younger, lifetime history of cocaine dependence and the presence of an affective, anxiety or personality disorder were associated with a possible ADHD. Conclusion: The estimated prevalence of ADHD in patients being treated for alcohol dependence is high, and the presence of a possible ADHD in adulthood is associated with an increase in psychiatric comorbidity.
Objective: We sought to elucidate the effects of an organization, time management, and planning (OTMP) skills training intervention for college students reporting elevated levels of ADHD symptomatology and academic impairment. Method: Undergraduate participants enrolled in either the intervention (n = 22) or comparison (n = 15) condition in exchange for psychology course credit. Those in the intervention condition attended three weekly group meetings designed to improve organizational skills. Treatment effectiveness was evaluated by comparing pre- and postmeasurements of academic impairment, inattention, hyperactivity/impulsivity, and OTMP skills utilization. Results: Intervention group participants improved significantly on ratings of inattention, hyperactivity/impulsivity, and academic impairment, relative to the comparison group. Intervention group participants also improved in their use of OTMP skills, relative to their baseline ratings. Conclusion: This study suggests an organizational skills intervention has the potential to ameliorating ADHD symptomatology and academic impairment among college students.
Objective: To compare ADHD patients who failed a symptom validity test with those who passed the test to explore whether there are signs of negative response bias on group level. Method: In our outpatient department, 196 adults were diagnosed with ADHD using a comprehensive diagnostic strategy featuring a detailed clinical history, clinical interview, observer rating, several self-rating scales, and neuropsychological attention tests. The Amsterdam Short Term Memory Test (AKGT) was applied as a symptom validity measure. Results: Sixty-three patients (32.1%) scored below the AKGT cutoff level. The two groups did not significantly differ regarding self-report and observer ratings. Those who failed the AKGT had higher reaction time variabilities in selective, auditory and visual divided attention, and higher omission errors in sustained attention. Conclusion: We found no strong indicators for negative response bias in ADHD patients who failed a symptom validity test. New measures and approaches to detect feigned ADHD should be developed.
Objective: Researchers are increasingly using Amazon’s Mechanical Turk (MTurk; www.mturk.com) to recruit study participants. However, the utility of MTurk for investigations of ADHD in adulthood is unknown. Method: A total of 6,526 MTurk workers (median age range = 26-35 years) completed an online screening survey assessing their diagnostic histories and symptoms of ADHD, as well as relevant demographic correlates and diagnostic comorbidity. Results: The prevalence of MTurk workers who reported being diagnosed as children and as adults, and the percentage of workers whose ADHD appeared to persist from childhood into adulthood, are consistent with those observed in "offline" samples. Relative to MTurk workers diagnosed with ADHD as adults, workers diagnosed with ADHD as children were more likely to be male and without college degrees, as well as less likely to have comorbid depression or anxiety disorders. Conclusion: Amazon’s MTurk holds promise as a recruitment tool for studying adults with ADHD.
Objective: To examine the validity of sluggish cognitive tempo (SCT) and ADHD–inattention (ADHD-IN) symptoms in children from Chile. Method: Mothers and teachers rated SCT, ADHD-IN, ADHD–hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection (teachers only) in 652 Chilean children (55% boys) aged 6 to 14 years. Results: For both mother and teacher ratings, the eight SCT symptoms and nine ADHD-IN symptoms showed substantial loadings on their respective factors (convergent validity) along with loadings close to zero on the alternative factor (discriminant validity). ADHD-IN showed a uniquely stronger relationship than SCT with ADHD-HI and ODD whereas SCT showed a uniquely stronger relationship than ADHD-IN with anxiety and depression. Although ADHD-IN uniquely predicted academic impairment and social difficulties, SCT did not. Conclusion: This study provides the first evidence for the validity of SCT among children outside of North America or Western Europe.
Objective: To characterize differences in presentation, diagnosis, and management of children/adolescents with ADHD in six European countries. Method: Physicians abstracted clinical records for patients aged 6 to 17 years, diagnosed from 2004 to 2007 and treated for ≥2 years. Documentation included impairment due to core ADHD symptoms and additional ADHD symptoms/behaviors at diagnosis, diagnostic approach, and treatment modality. Results: Study included 779 patients treated by 340 physicians. Prevalence of ADHD subtypes (inattention, hyperactivity/impulsivity, or combined) was similar across countries. Mean scores for core and noncore symptom impairment varied and were highest in Italy and the United Kingdom. Variability was noted in diagnostic approach; 95% of physicians in the Netherlands used Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria versus 10% in Germany. Differences were reported for initial treatment modality, treatment switching, and physician-reported treatment outcomes. Conclusion: European countries varied in diagnostic approaches and practice management of children/adolescents with ADHD.
Objective: We assess the diagnostic accuracy of the QbTest, which measures the cardinal symptoms of ADHD. Method: The study group comprised 182 children (mean age about 10 years), of whom 124 had ADHD and 58 had other clinical diagnosis of which 81% had ASD. Results: Only QbTest parameters for inattention and hyperactivity differentiated between ADHD and other clinical diagnoses at the p ≤ .01 level, not for measures of impulsivity. Sensitivity ranged from 47% to 67% and specificity from 72% to 84%. Positive predictive value ranged from 41% to 86%, and negative predictive value from 43% to 86%. Area under the curve varied from .70 to .80. Conclusion: The ability of the individual QbTest parameters to identify ADHD was moderate. The test’s ability to discriminate between ADHD subtypes was unsatisfactory.
Objective: To determine the prevalence and psychosocial correlates of ADHD among adolescents in Jos, Nigeria. Method: A cross-sectional descriptive two-stage study of 487 randomly selected participants using Kiddie–Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version (K-SADS-PL), Raven’s Standard Progressive Matrix (SPM) and the Children’s Global Assessment Score (CGAS). Results: The prevalence of ADHD was 8.8%. The subtypes found were inattentive (3.08%), hyperactive-impulsive (2.05%), and combined (3.08%); male:female ratio of 1.4:1. ADHD was significantly associated with use of substance by father (odds ratio [OR] = 0.35; 95% confidence interval [CI] = [0.154, 0.781]), use of substance by mother (OR = 0.2; 95% CI = [0.055, 0.711]), and lower education of mother (OR = 0.3 95% CI = [0.116, 0.693]). Poor quality of handwriting (2 = 8.120; p = .010) and impaired global functioning (t test = 10.756; p < .001) were significantly associated with ADHD in the adolescents. Conclusion: Given the burden of ADHD, efforts should be made to establish a system for the early identification and management.
Objective: To examine the effects of environmental noises (speech and white noise) relative to a no noise control condition on the performance and difficulty ratings of youth with ADHD (N = 52) on academic tasks. Method: Reading performance was measured by an oral retell (reading accuracy) and the time spent reading. Writing performance was measured through the proportion of correct writing sequences (writing accuracy) and the total words written on an essay. Results: Participants in the white noise condition took less time to read the passage and wrote more words on the essay compared with participants in the other conditions, though white noise did not improve academic accuracy. The participants in the babble condition rated the tasks as most difficult. Conclusion: Although white noise appears to improve reading time and writing fluency, the findings suggest that white noise does not improve performance accuracy. Educational implications are discussed.
Objective: Children with deficits in emotional regulation operationalized by scores on the Child Behavior Checklist (CBCL) Attention Problems, Aggressive Behavior, and Anxious-Depressed subscales are more likely than others to manifest adverse outcomes. However, the transmission of this profile has not been well studied. The main aim of this study was to investigate the familiality of this profile. Method: Participants were youth probands with bipolar I (BP-I) disorder (N = 140), ADHD (N = 83), and controls (N = 117) and their siblings. Based on the CBCL emotional dysregulation profile, we classified children with severe emotional dysregulation (aggregate cut-off score ≥210) and emotional dysregulation (aggregate cut-off score ≥ 180 and <210). Results: Emotional dysregulation profile scores correlated positively between probands and siblings. Conclusion: Youth with emotional dysregulation are at increased risk to have siblings with similar deficits, suggesting that emotional dysregulation runs in families.
Objective: The aim of this study is to understand the impact of a 5-day period of nap restriction on sleep patterns and cognitive function in typically developing preschoolers, aged 3 to 4 years. Method: Following 1 week of baseline assessment, 28 children were randomly assigned to either a "napping as usual" group (n = 15) or a 5-day period of nap restriction (n = 13). Sleep was assessed with sleep logs and actigraphy; cognition was assessed at baseline and at the end of the intervention week. Results: No group differences in sleep or cognitive function were observed at baseline. For the no-nap group, the 5-day period of daytime nap restriction resulted in increased nighttime sleep. Children in the no-nap group also showed a significant improvement in attentional control compared with baseline, whereas no such changes were observed among children in the napping-as-usual group. Conclusion: In preschool children who typically take naps, short-term nap restriction is associated with increased nighttime sleep and may contribute to improved attentional function.
Objective: Inattention may contribute to emotion recognition deficits in children with ADHD. In the current study, we compared the viewing patterns for emotion stimuli between children with and without ADHD and examined the relationship between viewing patterns, emotion knowledge accuracy, response time, and ADHD symptoms. Method: Eye-tracking technology recorded viewing patterns for emotion stimuli among 45 children (60% male; control n = 26, ADHD n = 19). Results: Overall, viewing patterns of children with and without ADHD were strikingly similar; however, small to large effect sizes (Cohen’s d = –0.73 to 0.93) across emotions suggest that, for some emotions, children with ADHD spend less time viewing relevant areas of images and take longer to respond (i.e., detect an emotion) compared with children without ADHD. Conclusion: Children with ADHD view some emotions differently from children without ADHD. The results provide an important foundation for additional work in this area.
Objective: To test if the relationship between ADHD and academic achievement is mediated by service utilization and/or study skills, and if these mediation effects are moderated by parental education level. Method: A bootstrapping method within structural equation modeling was used with data from 355 first year college students meeting strict criteria for ADHD or clearly without ADHD to test the mediation and moderation effects. Results: Study skills, but not service utilization, significantly mediated the relationship between ADHD status and GPA; however, this relationship was not significant among students with at least one parent holding a master’s degree or higher. Conclusion: Among first year college students study skills may be a more salient predictor of educational outcomes relative to ADHD status. Additional research into support services for college students with ADHD is needed, however, results suggest interventions targeting study skills may hold particular promise for these students.
Objective: This study assessed the effects of citicoline, a nutraceutical, on attention, psychomotor function, and impulsivity in healthy adolescent males. Method: Seventy-five healthy adolescent males were randomly assigned to either the citicoline group (n = 51 with 250 or 500 mg citicoline) or placebo (n = 24). Participants completed the Ruff 2&7 Selective Attention Test, Finger Tap Test, and the Computerized Performance Test, Second Edition (CPT-II) at baseline and after 28 days of supplementation. Results: Individuals receiving citicoline exhibited improved attention (p = 0.02) and increased psychomotor speed (p = 0.03) compared with those receiving placebo. Higher weight-adjusted dose significantly predicted increased accuracy on an attention task (p = 0.01), improved signal detectability on a computerized attention task (p = 0.03), and decreased impulsivity (p = 0.01). Discussion: Adolescent males receiving 28 days of Cognizin® citicoline showed improved attention and psychomotor speed and reduced impulsivity compared to adolescent males who received placebo.
Objective: Research assessing the social skills of children with ADHD has predominantly relied upon North American samples. In addition, most existing work has been conducted using methodology that fails to use a controlled peer stimulus; such methods may be more vulnerable to cultural influence. Method: We examined the social skills of 52 Spanish children (ages 8-12) with and without ADHD using a controlled Chat Room Task, which simulates a virtual social environment where peers’ responses are held constant, so that participants’ social skills may be assessed. Results: After statistical control of typing and reading comprehension skills, Spanish children with ADHD gave fewer prosocial comments and had greater difficulty remembering central details from the conversation between the peers, relative to comparison children. Conclusion: The virtual Chat Room Task may be useful to assess social skills deficits using a controlled paradigm, resulting in the identification of common social deficiencies cross-culturally.
Objective: Stereotype threat—faced when one confronts a personally relevant stereotype in a domain-relevant context—can significantly jeopardize individual performance in test-taking situations. Research has overlooked the potential for mental health labels to serve as bases for stereotype threat in such situations. This study examines whether ADHD, a disorder frequently serving as a basis for standardized testing accommodation, may trigger stereotype threat in testing situations. Method: Drawing from a sample of 114 participants (53 reporting a history of ADHD and 61 not reporting a history of ADHD), this study considers whether stereotype threat invoked on the basis of ADHD hinders performance on Graduate Record Examination (GRE) questions beyond the impact of symptomatology. Results: Participants reporting ADHD achieved significantly lower scores on verbal and quantitative GRE questions than participants without ADHD. Participants between the ages of 18 and 24 reporting ADHD who were explicitly exposed to stereotype threat achieved significantly lower scores on quantitative GRE questions than their ADHD-reporting peers who were not explicitly exposed to stereotype threat. Conclusion: Domain-relevant mental health labels may trigger stereotype threat in test-taking situations.
Objective: To evaluate health care experiences of adults with ADHD and to identify predictors for patient satisfaction. Method: Multisite, questionnaire-based survey in a cohort of adult patients diagnosed and treated for ADHD in the Bergen area of Western Norway between 2005 and 2011. Results: Among the 171 included patients, only 61 (35.7%) reported being satisfied to a large or very large extent with the received health care. The strongest predictor for overall satisfaction, independent of duration, medication, and reported outcome of treatment, was whether they were satisfied with the information they had received from clinicians regarding ADHD and treatment options. Patients who reported that they had been offered other treatments in addition to pharmacotherapy were generally more satisfied. Conclusion: Our results emphasize the importance of consistent information routines as part of ADHD management. More teaching and training about ADHD for clinicians working in adult psychiatric health services may be needed.
Objective: It would be useful to compare temporal changes in the diagnostic prevalence of ADHD obtained from identical population surveys with time-trend survey findings based on individual ADHD features. Method: Changes in the diagnostic prevalence of ADHD over time were recorded from parent reports and from physician office visit data. Associated features of ADHD were temporally recorded from standardized teacher, parent, and youth surveys. Results: Time-trend diagnostic findings on ADHD prevalence based on 6 parent surveys and 12 outpatient physician office visit surveys revealed consistent rate increases. By contrast, 26 sets of standard ratings of the primary and associated features of ADHD assessed systematically by different teachers, parents, and students during different years indicated little change. Conclusion: Time-trend national surveys of ADHD in youth over the last two decades reveal consistent increases in its diagnostic prevalence, whereas time-trend findings for individual ADHD-related symptoms remained relatively stable.
Objective:To compare the neuro-cognitive profiles among initial clinic referred medication naive sample of children with anxiety disorders (ANXs) and ADHD in a youth sample. Method: Three groups of patients, ANX (n = 40), ADHD (n = 48), and ANX + ADHD (n = 33), aged 7 to 12 years, were compared with respect to their Physical and Neurological Examination for Subtle Signs (PANESS) and cognitive measures (digit span, digit symbol, Trail Making Test [TMT]-A and TMT-B, Stroop test). Results: ADHD group performed worse than the other two groups with regard to soft signs and cognitive test performance; ANX + ADHD were impaired relative to ANX but better than ADHD. Significant differences were found for gait and station problems, overflows and timed movements, TMT error points, and Stroop interference scores. ADHD patients had more difficulty in warding off irrelevant responses and lower speed of time-limited movements. Conclusion: This clinical evaluation study suggested that ANX and ADHD seem to have significantly different neuro-cognitive features: Poorest outcomes were observed among children with ADHD; rather than problems of attention, inhibitory control deficits were the most prominent differences between ANX and ADHD; and the presence of ANX appears to have mitigating effect on ADHD-related impairments.
Objective: ADHD is one of the most common childhood psychiatric disorders. Research indicates that there is some link between obesity/overweight and ADHD, though the mechanism of this association remains uncertain. It is the aim of the present study to explore the association between ADHD, obesity, and plasma leptin, neuropeptide Y (NPY), and adiponectin levels. Method: Thirty-six patients diagnosed with ADHD were included in the study. The control group consisted of 40 healthy children and adolescents who had similar age and gender features with the patient group. Plasma leptin, adiponectin, NPY levels were measured, and body mass index (BMI), weight for height, and standard deviation scores (SDS) of height, weight, and BMI were calculated. Results: No significant difference was found between patients and healthy children in terms of BMI and BMI percentile. Participants were classified into three groups according to their weight to height values. There was no significant difference between the two groups, but 10% of the control group and 30.6% of the ADHD group were classified as overweight, which was 3 times higher than the control group. The adiponectin plasma level was significantly lower and leptin/adiponectin (L/A) ratio was significantly higher in the ADHD group. There was no significant difference between serum NPY levels. In the ADHD group, the mean leptin plasma level was high, but was not statistically significant. Conclusion: We think that a low adiponectin level and high L/A ratio may be the underlying mechanism of the obesity in ADHD patients.
Objective: Children with ADHD-combined type (ADHD-C), disruptive mood dysregulation disorder (DMDD), and healthy controls (HC) were compared with respect to the sociodemographic features, psychiatric comorbidities, behavioral patterns, and family functioning. Method: Research groups were identified using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). Conners’ Rating Scale–Revised Long Form, Wechsler Intelligence Scale for Children–Revised (WISC-R) test, Sociodemographic Questionnaire, and Family Assessment Device (FAD) were administered to research groups. Results: DMDD group’s rate of psychiatric comorbidity was higher than the ADHD-C group’s rate. In most of the subscales of Conners, DMDD group’s average scores were higher than the other groups’ scores. In "Communication," "Affective Responsiveness" subscales of FAD, DMDD group’s average scores were higher than the ADHD-C group’s scores. In "Affective Involvement," "General Functioning" subscales of FAD, DMDD group’s average scores were higher than the other groups’ scores. Conclusion: Children with DMDD were distinguished from children with ADHD-C by their higher comorbidity rate, more impaired behavioral patterns, and family functioning.
Objective: Youth with ADHD experience significant impairment in peer functioning. Based on recommendations from the literature, the current pilot study examined the effectiveness of a parent-assisted, friendship-building program at establishing mutual friendships and improving peer relationships in adolescents with ADHD. Method: Participants included 20 adolescents with ADHD (ages 11-16 years) and their parent(s). Families completed the Program for the Evaluation and Enrichment of Relational Skills (PEERS). Measures of friendship quality, social knowledge, social self-efficacy, get-togethers, and peer conflict were completed at baseline and post-treatment. At post-treatment, participants also reported on the initiation of a new friendship. Results: Baseline to post-treatment differences were examined using paired-samples t tests. The majority of participants reported the initiation of a new friendship at post-treatment. Adolescents also demonstrated significantly improved social knowledge and increased get-togethers. Effect sizes were large. Conclusion: Following participation in PEERS, adolescents improved in several peer functioning domains and many initiated new friendships.
Objective: The main goal of the current study is to investigate whether intrinsic motivation and behavioral engagement mediate the association between inattention symptoms and academic achievement (reading, writing, and mathematics), as well as to document the extent to which inattention symptoms contribute to academic achievement due to variance overlapping with intrinsic motivation and behavioral engagement. Method: Participants were 92 children (Grades 1-4). Data were gathered using a combination of parent and teacher reports as well as objective assessments. Results: Results did not support the mediating role of intrinsic motivation and behavioral engagement. A commonality analysis showed that 77.44% to 82.10% of the variance explained in each academic achievement domains was due to variance shared by inattention symptoms, intrinsic motivation, and behavioral engagement. Conclusion: These results suggest more commonality than differences between inattention symptoms, intrinsic motivation, and behavioral engagement with regard to their association with academic achievement. The implications of these findings are discussed.
Objective: The aim of this study was to determine whether the serotonin transporter-linked polymorphic region (5-HTTLPR) L (long)/S (short) polymorphism is associated with susceptibility to ADHD. Method: We conducted a meta-analysis of case-control associations and the transmission disequilibrium test (TDT) between the 5-HTTLPR L/S polymorphism and ADHD. Results: A total of 19 comparison studies were included in this meta-analysis. Our meta-analysis of the case-control studies showed no association between ADHD and the 5-HTTLPR S allele, for all study participants (odds ratio [OR] = 1.075, 95% confidence interval [CI] = [0.990, 1.167], p = .085), or for the European or Asian population. The TDT indicated no association between ADHD and the 5-HTTLPR S allele, for all study participants (OR = 1.078, 95% CI = [0.962, 1.207], p = .196). Conclusion: This meta-analysis of case-control studies and TDT showed a lack of association between the 5-HTTLPR L/S polymorphism and ADHD.
Objective: Mixed-handedness among children has recently been proposed as a marker of neurodevelopmental disorder and ADHD. This study expanded this initial evidence to the questions of whether mixed-handedness as well as mixed-footedness are similarly associated with ADHD among adults. Method: Self-reported ADHD symptoms, handedness, footedness, and current depression and anxiety were assessed in a large, heterogeneous general population sample (N = 2,592). Latent variable analysis was used to investigate the structure and measurement properties of ADHD symptoms, the dimensionality of footedness, and the classification of lateral preferences. Results: Mixed-footedness was associated with probable ADHD (odds ratio [OR] = 1.76 [1.07, 2.89], p = .026). Left- and mixed-footedness were associated with higher inattention and impulsivity scores. Conclusion: Developmental continuities of the associations of mixed lateral preferences with ADHD from child to adult age seem to exist. In particular, mixed-footedness, rather than mixed-handedness, appears to be an ADHD marker among adults.
Objective: To study the association between general anesthesia exposure before age 3 years and having a later ADHD diagnosis. Method: In a birth cohort, data were collected from a nationwide population database for children born between 1997 and 1999 who were exposed to general anesthesia before their third birthday. Age- and gender-matched enrollees without general anesthesia exposure were taken as the comparison. Groups were compared to identify the incidence of ADHD after age 4 and anesthesia-related predictive factors. Results: Among the 1,146 exposed children, 74 ADHD cases were identified, and 158 ADHD cases were identified in 3,438 matched controls. After adjusting for comorbid conditions and possible confounding factors, if exposure on more than one occasion or ≥3 hr, an increased likelihood of having a later ADHD diagnosis was found (HR, 1.71 and 2.43, respectively). Conclusion: Children with multiple or ≥3 hr general anesthesia exposures before age 3 years have an increased likelihood of a later ADHD diagnosis.
Objective: To examine (a) physical and daily functioning in children with ADHD and autism spectrum disorder (ASD) compared with ADHD alone and (b) whether decreased physical quality of life (QoL) is associated with increased emotional and behavioral problems in children with ADHD-ASD. Method: Cross-sectional study comprising 392 children with confirmed ADHD (ADHD-ASD, n = 93; ADHD alone, n = 299) recruited from 21 pediatric practices in Victoria, Australia. Data were collected via parent and teacher surveys. Key measures included the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL). Results: Children with ADHD-ASD had poorer QoL across both psychosocial and physical health domains, and also had greater parent-reported behavioral, emotional, and peer problems, compared with children with ADHD alone. Poorer physical QoL partially mediated the relationship between comorbid ASD status and poorer emotional and behavioral functioning. Conclusion:The comorbid overlay of ASD in ADHD appears to influence not only problems in physical functioning but also the severity of problems relating to areas of emotional and behavioral functioning.
Objective: The aim of the present study was to investigate the specificity of inhibition, working memory (WM), and reaction time variability (RTV) in relation to symptoms of ADHD and autism spectrum disorder (ASD). Method: A community-based sample of schoolchildren aged 7 to 9 years (N = 200) completed tasks designed to measure inhibition, WM, and RTV. Results: All neuropsychological functions were related to symptoms of both ADHD and ASD. The results from regression analyses showed that inhibition and RTV were related specifically to ADHD symptoms when controlling for symptoms of ASD. Regarding WM, no specific association with either symptom domain was evident after controlling for the other. Furthermore, independent contributions of inhibition and RTV were found in relation to ADHD symptoms after controlling for ASD symptoms. Conclusion: The present study underscores the relevance of controlling for ADHD symptoms when examining ASD symptoms in relation to neuropsychological functions.
Objective: The aim of the study was to identify factors for treatment non-persistence in patients with ADHD. Method: Data for 100 patients with ADHD aged 5 to 16 who completed the Kiddie-Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version–Korean Version (K-SADS-PL-K) and Korean Wechsler Intelligence Scale for Children (K-WISC) were obtained between 2008 and 2013. Patients were classified as treatment-persistent and treatment-non-persistent based on 6-month follow-up. Sociodemographic data, comorbidities, intelligence quotient (IQ), severity, and social/school functioning were compared. Results: Adolescence and poor parental spousal relationships significantly predicted treatment non-persistence. Although comorbid major depressive disorder and absence of transient tic disorder were associated with treatment non-persistence, there was no difference in overall psychiatric comorbidity. No differences existed for IQ, Clinical Global Impressions–Severity (CGI-S) score, peer relationships, and academic achievement. Conclusion: Lower treatment persistence was associated with adolescence, comorbid depression, absence of tics, and poor parental spousal relationships, but not with symptom severity or impairment of the disorder.
Objective: To date, treatment programs for adult domestic violence (DV) or intimate partner violence (IPV) have had minimal impact. To make treatment more effective, programs should be adjusted to psychopathology of the offender. As emotional lability and poor emotional self-regulation and self-control are common features of ADHD, it may play a pivotal role as a predictor for adult DV/IPV. Method: This systematic review synthesizes the available evidence for childhood and/or adult ADHD being a risk factor for DV/IPV. Results: Four case control studies and three cohort studies were included in the review. Although three case control studies showed positive associations between childhood and/or adult ADHD and adult DV/IPV, two did insufficiently control for the presence of comorbid Conduct Disorder (CD) or Antisocial Personality Disorder (ASPD). Conclusion: Cohort studies identified hyperactive, impulsive, and inattention symptoms as risk factors for adult IPV. CD and ASPD were regarded as mediators in three studies.
Objective: Exercise has attracted attention as a potential helpful intervention in children with ADHD. Effects are emphasized on cognition, social-emotional, and motor development. Method: A systematic literature search was conducted using the electronic databases Web of Science, PubMed, Scopus, and ERIC to analyze the efficacy of different types of exercise interventions in children and adolescents with ADHD. Seven studies examining the acute and 14 studies examining the long-term effects were included. Results: The largest effects were reported for mixed exercise programs on ADHD symptomatology and fine motor precision. However, because of the large differences in the study designs, the comparability is limited. Conclusion: At that time, no evidence-based recommendation can be formulated regarding frequency, intensity, or duration of exercise. Nevertheless, some first trends regarding the effects of certain types of exercise can be identified. When focusing on long-term health benefits in children and adolescents with ADHD, qualitative exercise characteristics might play an important role.
Objective: This pilot randomized controlled trial examined the acceptability and feasibility of a cognitive-behavioral therapy (CBT) intervention for children with ADHD and anxiety, and provided preliminary information on child and family outcomes. Method: Children with ADHD and anxiety (8-12 years) were randomized to receive an adapted version of the Cool Kids CBT program or usual clinical care. Key outcomes included feasibility and acceptability of the intervention (participant enrollment, drop-out, intervention session attendance), remission of anxiety assessed via diagnostic interview, ADHD symptom severity, quality of life (QoL), and parent mental health. Results: Twelve children participated (67% uptake). Most families attended all 10 intervention sessions, with no drop-outs. Intervention participants had marked improvements in both child and family well-being by parent and teacher report, including anxiety, ADHD symptom severity, QoL, and parent mental health. Conclusion: Non-pharmacological interventions may improve important domains of functioning for children with ADHD and anxiety, including ADHD symptom severity.
Objective: The objective of this study was to assess whether comparisons of longitudinal smoking trajectories predict differences in symptoms of ADHD in adults. Method: Participants were interviewed 7 times between 14 and 43 years of age. ADHD symptoms at outcome were assessed with the World Health Organization ADHD Self-Report Scale. Bivariate and multivariate linear regression analyses assessed the associations between the trajectories of smoking and ADHD symptoms. Results: The multivariate analysis (R 2 = .12) indicated that compared with being nonsmokers, the probability of being in the heavy/continuous group (standardized regression coefficient [SRC] = .17, p < .01) and in the late starter group (SRC = .11, p < .05) were significantly associated with adult ADHD symptoms. Conclusion: Longitudinal smoking patterns were associated with ADHD symptoms in adults. Chronic smoking jeopardizes both physical health and the ability to fulfill adult roles as employees, family members, and friends. Smoking cessation in adolescence may lessen the likelihood of ADHD symptoms in adulthood.
Objective: To evaluate and describe the performance during the learning process of risk-detection versus risk-benefit processing in adolescents diagnosed with ADHD. Method: Thirty-five adolescents with ADHD and 26 paired controls participated. The tests applied are Iowa-type children version paradigm and Stroop test. Results: Adolescents with ADHD exhibited lower risk-benefit processing capacity and lower ability to detect risk selections; main findings also indicate that adolescents with ADHD were slower to learn to avoid risk choices. In addition, they also presented a deficient inhibitory control. Conclusion: Results confirm the presence of a deficit in advantageous choice in adolescents with ADHD. By providing a measure of risk choice—and not only a net score—we show that adolescents with ADHD also fail to avoid risk choices. This deficit is mainly because they are slower in learning how to avoid risk choices, and not simply deficient. Literature is scarce concerning studies with Iowa-type paradigms in samples intregated exclusively by adolescents. More research is needed to clarify the nature of these deficiencies.
Objective: To conduct an open trial assessing the initial efficacy of an intervention focusing on increasing skills related to academic performance (planning, organization, studying, and homework behaviors) for middle school children diagnosed with ADHD. The intervention is modeled on evidence-based interventions but designed for administration in the outpatient setting. Method: Parents and their children diagnosed with ADHD attended seven weekly group sessions targeting academic, organizational, and homework skills. Parents completed the Homework Problem Checklist and Impairment Rating Scale pre- and post-treatment. Results: Following intervention, significant improvements in homework completion and management, as well as reductions in academic impairment and improvements in parent confidence and family relations, were reported. Conclusion: Despite limitations including small sample size and lack of a control group, our results demonstrate initial efficacy of an academic skills intervention designed for use in the outpatient setting with middle school children diagnosed with ADHD on clinically relevant outcome measures.
Objective: To test the previously suggested hypothesis that those with comorbid ADHD and Conduct Disorder (CD) diagnoses differ from other antisocially involved youth in terms of higher rates of violent behavior, impulsiveness, and psychopathic traits. Method: Three hundred eighty juvenile incarcerated delinquents from Northern Russia were assessed by means of semi-structured psychiatric interview and by student and teacher self-reports. Results: The study has demonstrated higher rates of psychiatric disorders and of comorbidity, as well as more complicated substance abuse and disruptive behaviors in those with combined ADHD–CD diagnosis, as compared with CD only, ADHD only, and no CD no ADHD groups. The results regarding psychopathic traits were inconclusive. Conclusion: The group with combined ADHD–CD diagnosis is more severely disturbed, both as concerns psychiatric comorbidity and more severe aggressive and disruptive behaviors. However, there is only limited evidence supporting a higher prevalence of psychopathic traits in this group.
Objective: The purpose of this study was to investigate the overlap between executive functions and temperament as measured by two questionnaires and to examine characteristic profiles in children with ADHD and clinical controls. Method: Parents of 111 clinically referred children, half of whom were diagnosed with ADHD and half with other or no diagnoses, completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Cloninger Junior Temperament and Character Inventory (JTCI). Results: Factor analysis of both instruments resulted in three common factors representing aspects of (1) cognitive regulation, (2) behavioral regulation, and (3) anxious/rigid tendencies. Factor (4) represented strengths and positive resources and loaded on JTCI scales only. Both instruments discriminated significantly between ADHD and non-ADHD children. Conduct disorder/oppositional defiant disorder (CD/ODD) but not ADHD accounted for problems in BRIEF Emotional Control and Self-Monitor and JTCI low Cooperativeness. Conclusion: The two instruments only partially overlap and may complement each other.
Objective: The study of ADHD uses various computerized tests to assess cognitive functions. Uncertainty exists regarding the association between deficits found by different tools testing similar or different cognitive functions (e.g., continuous performance tests [CPT] and response inhibition [RI] tests).We hypothesized that different tools that measure continuous performance will be better correlated between themselves than with a tool that examines RI. Method: Thirty-six adults with ADHD performed two different CPTs and a RI task. We analyzed correlations between different measures examined by the tasks. Results: There were strong correlations between corresponding measures in the CPTs. Correlations between the results in CPT and the RI task were only minimal. Conclusion: These findings support the specificity of impairments in different cognitive domains (continuous attention vs. RI) beyond the specific test used in the study of ADHD. Also, these findings strengthen the importance of specific discriminative cognitive domains in ADHD.
Objective: ADHD is defined as impairment to self-regulatory behavior and executive functioning (EF). Many students with other learning disabilities (LD) also experience EF impairments. With the rising number of students with ADHD and LD enrolling in higher education, it is important to recognize the challenges these students face and to provide effective support when transitioning from secondary to postsecondary school. This article examines the challenges of the transition from secondary to postsecondary environments, specifically with the student diagnosed with ADHD and/or other LD. Method: Scholarly articles relating to the efficacy of EF coaching as well as students with ADHD and/or other LD transitioning from secondary to postsecondary school were examined and then considered for best practices in EF coaching. Results: Although the literature supports that EF coaching can improve EF skills, there is a paucity of empirical studies that examines the efficacy of EF coaching (Franklin & Franklin, 2012). The literature also supports the use of EF coaching for students with ADHD and/or LD when transitioning from highschool to college, however limited research has been published to date. Conclusion: With the finite research available in the field of coaching, recommendations for future consideration and research is included to support the need for evidence-based programs. An EF coaching model at Lynn University’s Institute for Achievement and Learning (IAL) is discussed and addresses how students are supported during their first year at the University.
Objective: We conducted a two-period (open-label and double-blind) pilot investigation of droxidopa, with and without carbidopa, for ADHD. Method: Twenty adult ADHD patients received open-label droxidopa titrated from 200 to 600 mg 3 times per day (TID; Weeks 1-3), then open-label droxidopa plus carbidopa titrated from 25 or 50 mg TID (Weeks 4-6). In Weeks 7 to 8, patients were randomized to continued co-treatment or matching placebo substitution. Results: Improvements in mean total Adult ADHD Investigator Symptom Report Scale (AISRS) scores were seen at Week 1 (p < .0001) and Week 3 (p < .0001). Improvements were maintained but not increased with carbidopa. Thirteen of 20 patients completed open-label treatment. In the double-blind period, mean total AISRS scores were similar between the co-treatment (n = 6) and placebo (n = 5) groups. No serious adverse events were reported. Conclusion: These preliminary findings indicate that droxidopa can improve adult ADHD symptoms. Further studies are warranted to examine the efficacy and safety of droxidopa in ADHD.
Objective: To investigate verbal memory function with relation to working memory (WM) and response inhibition (RI) in adults with ADHD. Method: Verbal memory function was assessed by the California Verbal Learning Test–Second Edition (CVLT-II), WM by the Paced Serial Addition Test, and RI by the Color-Word Interference Test from Delis–Kaplan Executive Function System in a sample of adults with normal to high intellectual function (IQ). Results: The ADHD group (n = 74) obtained lower scores than controls on measures of learning, recall, and immediate memory (CVLT-II). WM and RI explained a substantial part of verbal memory performance in both groups. A group to executive function (EF) interaction effect was identified for the total number of intrusions and false positive responses on the CVLT-II recognition trial. Conclusion: Verbal memory performance only partially overlaps with EF in intellectually well-functioning adults with ADHD. Both EF and verbal memory function should be assessed as part of a neuropsychological evaluation of adults with ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To examine whether a familial tendency exists in clinical response to methylphenidate. Method: Nineteen pairs of siblings or parent–child stimulant-naive individuals with ADHD were prescribed methylphenidate–immediate release, and were comprehensively evaluated at baseline, Week 2, and Week 4, using the ADHD Rating Scale IV, Clinical Global Impression Scale, and the Barkley Side Effects Rating Scale. Results: We found significant intraclass correlations in family member response to methylphenidate–immediate release and side effect profile, including emotional symptoms and loss of appetite and weight. Conclusion: Family history of response to methylphenidate should be taken into account when treating ADHD.
Objective: Assessment of the prevalence of overweight and obesity in children and adolescents with ADHD with emphasis on pharmacological treatment and comorbid disorders. Method: We analyzed 408 medical records of patients with ADHD aged 7 to 18. Results: The prevalence of overweight (14.71% vs. 12.83%, 2 = 3,586.43, p < .001) and obesity (6.37% vs. 3.45%, 2 = 3,588.19, p < .001) was significantly higher in children with ADHD compared with the population. There was significantly higher incidence of obesity in patients with comorbid diagnosis of adjustment disorder (22.22% vs. 4.42%, 2 = 5.66, p = .02) and mental retardation (19.05% vs. 4.42%, 2 = 7.63, p = .005). Pharmacological treatment was associated with a higher incidence of obesity (8.37% vs. 2.76%, 2 = 4.92, p = .03). Conclusion: Standardized body mass index (BMI), prevalence of overweight, and obesity was higher in patients with ADHD compared with the population. Higher incidence of obesity was shown in patients with analyzed comorbidities.
Objective: Deficits in response inhibition figure prominently in models of ADHD; however, attentional deficiencies may better explain previous findings of impaired response inhibition in ADHD. We tested this hypothesis at the neurophysiological level. Method: Dense array ERPs (event-related potentials) were obtained for 46 children with ADHD and 51 controls using the stop-signal task (SST). Early and late components were compared between groups. N2 and P3 components were localized with LAURA distributed linear inverse solution. Results: A success-related N1 modulation was only apparent in the ADHD group. N2 and P3 amplitudes were reduced in ADHD. During the successful inhibition N2, the ADHD group showed reduced activation in right inferior frontal gyrus (rIFG), supplementary motor area (SMA), and right temporoparietal junction (rTPJ), and during failed inhibition in the rIFG. During the successful inhibition P3, reduced activation was found in anterior cingulate cortex (ACC) and SMA. Conclusion: Impairments in the ventral attention network contribute to the psychopathology of ADHD and challenge the dominant view that ADHD is underpinned by impaired inhibitory control.
Objective: To address the nature of associations between ADHD symptoms and posttraumatic stress disorder (PTSD) psychopathology in adult military veterans. Method: Ninety-five combat veterans, with PTSD (n = 63) and without PTSD (n = 32), were recruited for this study. PTSD was assessed with the Clinician-Administered PTSD Scale (CAPS) and ADHD was assessed with Connors’ Adult ADHD Rating Scale–Self-Report: Short Version (CAARS-S:S). Results: PTSD participants endorsed greater hyperactivity or restlessness, inattention or memory problems, and impulsivity or emotional lability scores than participants without PTSD. Among PTSD participants, inattention or memory problems and impulsivity or emotional lability were significant predictors of total PTSD symptoms, but only inattention or memory problems significantly predicted PTSD symptoms when other ADHD symptom clusters were considered simultaneously. Conclusion: Our data suggest that inattention may serve as a risk factor for posttraumatic stress symptoms following combat exposure.
Objective: Group A Streptococcus has been associated with ADHD, tic disorders (TD), and obsessive–compulsive disorder (OCD) through anti-basal ganglia antibodies (ABGA). Method: We investigated the association between ABGA and streptococcal exposure with behavioral, motor, and cognitive measures in 38 children with ADHD not comorbid to OCD or TD (nc-ADHD) and in 38 healthy children. An additional group of 15 children with TD and/or OCD was examined. Results: ABGA titers were present in 3% of nc-ADHD patients and controls but in 27% of TD and/or OCD patients. Evidence of streptococcal exposure was similar between ADHD patients and controls living in the same urban area. Behavioral, motor, and cognitive measures were not associated with anti-streptococcal antibodies. Conclusion: ABGA do not distinguish nc-ADHD from controls. The differences in the frequency of streptococcal exposure in previous studies are determined by the dynamic nature of the infection rather than the behavioral phenotype of ADHD.
Objective: To estimate a minimal clinically important difference (MCID) on the adult ADHD Quality of Life (AAQoL) scale. Method: The MCID was determined from data from short-term (N = 537) and long-term (N = 440), placebo-controlled atomoxetine trials in adults with ADHD. For the anchor-based approach, change in clinician-rated Clinical Global Impressions–ADHD–Severity (CGI-ADHD-S) scores was used to derive MCID. For the distribution-based approach, baseline-to-endpoint mean (SD) changes in AAQoL scores corresponding to 0.5 SD were computed. Results: The MCID was similar (approximately 8-point difference) between the short-term and the long-term treatment groups when either the anchor-based or distribution-based approach was used. Conclusion: These results suggest that approximately 8 points in the change from baseline on the AAQoL is a MCID.
Objective: Given the link between negative body image and depression symptoms, body image may affect the association between ADHD and depression symptoms. We evaluated the degree to which a variety of body image constructs mediated the association between ADHD and depression symptoms. Method: Participants were undergraduate psychology students (N = 627, age: M = 20.23, SD = 1.40, 60% female, 47% European American) who completed an online assessment. Results: Results indicated that ADHD symptoms were indirectly associated with increased depression symptoms, and that negative evaluation of physical appearance, overweight preoccupation, and body dissatisfaction mediated the association between ADHD and depression symptoms. ADHD symptoms were also directly associated with increased depression symptoms. Conclusion: Body image appears to play a role in the association between ADHD and depression symptoms for college students. Implications for future research and clinical practice are discussed.
Objective: Several studies suggest that parental ADHD impedes behavioral parent training (BPT) outcomes. Parental ADHD symptoms exhibited during BPT may interfere with the acquisition of new skills. This study explored the observed behavior of parents with ADHD during BPT. Method: Parents of children with ADHD attending group BPT completed self-ratings of their ADHD symptoms. Parents indicating a moderate level of ADHD symptoms were administered a clinical interview, and 37.3% of parents met ADHD criteria based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) clinician-rated symptom counts. Results: Parents with high ADHD symptoms displayed more total and off-task violations compared with parents with low ADHD symptoms, although no significant differences emerged for other behaviors (i.e., working quietly, using materials appropriately, and remaining in seat), absences, or tardiness. Conclusion: Parental ADHD symptoms were manifested during BPT. Future research should clarify the nature of parental behavior in BPT as a possible mechanism explaining the relation between parental ADHD and impaired BPT outcomes.
Objective: This study investigated the relationship between motor performance; attentional, hyperactive, and impulsive symptoms; and social problems. Correlations between parents’ versus teachers’ ratings of social problems and ADHD symptomatology were also examined. Method: A total of 129 children aged 9 to 12 years were included. ADHD symptoms and social problems were identified based on Conners’ Rating Scales–Revised: L, and the McCarron Assessment of Neuromuscular Development was used to assess motor skills. Results: After controlling for ADHD symptomatology, motor skills remained a significant predictor of social problems in the teacher model but not in the parent model. After controlling for motor skills, inattentive (not hyperactive-impulsive) symptoms were a significant predictor of social problems in the parent model, whereas hyperactive-impulsive (not inattentive) symptoms were a significant predictor of social problems in the teacher model. Conclusion: The findings suggested that intervention strategies should consider the interaction between symptoms and environmental contexts.
Objective: To examine the distribution of parent- and teacher-rated ADHD symptoms in a Turkish community sample to identify children at high risk for ADHD and to explore the psychosocial correlates of these high-risk children. Method: An 18-item SNAP-IV (Swanson, Nolan, and Pelham) and a three-item impairment scale were completed by parents and teachers on 3,110 children between 7 and 14 years of age from three public schools in Istanbul. Results: Using various case definitions for ADHD, we observed a range of prevalence estimates based on parent (2.7%-9.6%) and teacher (2%-10.1%) reports. Teacher-identified ADHD was associated with low family income and low parental education; parent-identified ADHD was associated with perceived need for mental health treatment. Conclusion: Statistically driven threshold on a symptom scale may overestimate the rate of high-risk children. Relying on one informant is likely to miss some children at high risk. As in clinical practice, therefore, data from multiple informants and evidence of impairment are essential for identifying ADHD.
Objective: The aim of the present study was to explore the prevalence and comorbidity rates of ADHD in a community sample of school-age children. Method: Participants were 1,508 children aged 6 to 14 years. Parents and teachers of each child completed the Turgay Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S). Screen-positive cases were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). Diagnoses were based on DSM-IV criteria. Results: The prevalence rate of ADHD was 8%. Children from extended families had extremely high rates (46.4%) of ADHD. Sixty percent of children with ADHD had one or more comorbid diagnoses. The most common comorbidities were learning disorders (35.7%) and oppositional defiant disorder (22.6%). Conclusion: The prevalence and comorbidity rates of ADHD in school-age children in Turkey are similar to those found in previous studies in other countries.
Objective: To explore the relationship between the Conners’ Kiddie Continuous Performance Test (K-CPT) performance and parent-report measures of child behavior and executive functioning, and clarify the role of sex in K-CPT performance in preschoolers. Method: Mothers and children recruited to the Health Outcomes and Measures of the Environment Study with complete 5-year assessment data relevant to the analyses were included (N = 127). We examined the association between K-CPT scores and Behavior Assessment System for Children–Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) scores, with covariate adjustment. Results: We found no significant associations between K-CPT, BASC-2, and BRIEF scores in the full sample. In sex-stratified analyses, we found unusually fast reaction time on K-CPT was related to executive control difficulties in girls, whereas unusually slow reaction time was related to the same difficulties in boys. Omission errors were associated with executive difficulties only in boys. Conclusion: The K-CPT may prove to be a useful indicator for early onset of executive control difficulties in preschool-aged children.
Objective: Neurofeedback (NF) is gaining recognition as an evidence-based intervention grounded in learning theory, and 19-channel z-score NF (19ZNF) is a new NF model. This pilot study sought to evaluate the efficacy of 19ZNF in a clinical setting. Method: Outcome measures framed groups such that 19ZNF was evaluated, as it relates to the neuropsychological constructs of attention (n = 10), executive function (n = 12), behavior (n = 14), and electrocortical functioning (n = 21). One-tailed t tests compared pre–post difference scores. Results: For all pre–post comparisons, the direction of change was in the predicted direction, and differences were statistically significant (p = .000 to p = .008, effect sizes 1.29 to 3.42). Conclusion: Results suggest 19ZNF improved attention, executive function, behavior, and electrocortical function. This study provides beginning evidence of 19ZNF’s efficacy, adds to what is known about 19ZNF, and offers an innovative approach for using quantitative electroencephalographic (QEEG) metrics as outcome measures.
Objective: Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) are thought to reflect the high, symptomatic extreme of quantitative trait continua. However, extreme deviations in either direction on disorder continua, high and low, may both represent maladaptive behavioral and cognitive outcomes. We aimed to test this hypothesis. Method: In a population sample of 378 children, ADHD and ASD traits were rated by parents on questionnaires that provide resolution at high and low extremes of the ADHD and ASD trait continua. ADHD and ASD traits were related to parent-ratings of internalizing and externalizing behavior problems and tests of cognitive functioning using polynomial regression. Results: The low ends of the ADHD and ASD trait continua were related to fewer behavior problems and better cognitive functioning than symptomatic ends. Conclusion: Studying the correlates of the low continuum ends may deepen our understanding of the mechanisms underlying adaptive behavioral and cognitive outcomes.
Objective: ADHD has been repeatedly linked to problems in social functioning. Although some theories assume that the emotion recognition deficits are explained by general attentional deficits, mounting evidence suggests that they may actually constitute a distinct impairment. However, it remains unclear whether the deficient processing affects specific emotional categories or may generalize to all basic emotions. The present study aims to investigate these questions by assessing the sensitivity to all six basic emotions in adults with ADHD. Method: The participants judged the emotion onset in animated morph clips displaying facial expressions that slowly changed from neutral to emotional. Results: ADHD participants exhibited an impaired recognition of sad and fearful facial expressions. Conclusion: The present findings indicate that ADHD is possibly associated with a specific deficit in the recognition of facial emotions signaling negative social feedback.
Objective: Despite advances in our understanding of ADHD as a neurodevelopmental disorder, robust biomarkers are yet to be established in clinical practice. More than 40 years of electroencephalography (EEG)-based research has culminated in the recent Food and Drug Administration (FDA) approval of the theta/beta (EEG power) ratio (TBR) as a diagnostic marker of ADHD. Method: This review article focuses on resting-state EEG power research in ADHD. Results: Inconsistent findings in the literature and suggestions of reduced specificity threaten the utility of TBR as a biomarker of ADHD. The use of fixed EEG bands may be a significant limitation, particularly in youth, and alternative approaches are needed. Conclusion: We propose that a personalized theta-to-alpha cut point or "transition frequency" is a better frame of reference for the measurement of TBR. Such an approach is better placed to test maturational lag and cortical hypoarousal models of ADHD and may in turn have greater utility in supporting diagnosis.
Objective: In the present study, we created a new valid rating scale to estimate the prevalence of ADHD among school-age children in Fayoum City. Method: We conducted two consequential studies (Studies 1 and 2). In Study 1, the sample comprised 106 children. The ages of the sample participants ranged between 6 and 14 years. The purpose of that study was to validate a new Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5)-based ADHD rating scale. In Study 2, the sample consisted of 420 children with ages ranging from 6 to 14 years. We used the new rating scale to estimate the prevalence of ADHD. Results: The first study showed that the new rating scale for ADHD was valid. The second study revealed that the prevalence of ADHD in Fayoum City was 20.5%, with 33.8% among boys and 6.8% among girls. Conclusion: We validated a new ADHD rating scale and estimated the prevalence of ADHD in Fayoum City for the first time in Egypt.
Objective: Neurodevelopmental disorders, including Reading Disorder, Disorder of Written Expression, and Developmental Coordination Disorder, often co-occur with ADHD. Although research has identified increased functional impairment in the presence of these comorbid diagnoses, few direct comparisons of intellectual profiles have been conducted. Thus, the present study examined Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV) profiles of children with ADHD alone and with comorbid neurodevelopmental disorders. Method: Participants included 296 children with ADHD, ADHD with Developmental Coordination Disorder, and ADHD with Reading Disorder and/or Disorder of Written Expression. Results: Comparisons of these groups suggests children with ADHD and language-based Learning Disorders have poorer working memory than children with only ADHD. Furthermore, children with ADHD and Developmental Coordination Disorder perform relatively better on verbal compared with perceptual reasoning indexes. Conclusion: These intellectual profiles may have utility in identifying cognitive weaknesses inherent to these disorders and may be used to guide treatment intervention.
Objective: The purpose of this study was to evaluate the effect of altitude on rates of ADHD. As decreased dopamine (DA) activity has been reported with ADHD and hypoxia has shown to be associated with increased DA, we hypothesized that states at higher altitudes would have lower rates of ADHD. Method: State estimates from the 2007 National Survey of Children’s Health (NSCH) report and 2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) report were used to extract the percentages of youth ages 4 to 17 diagnosed with ADHD. Results: Both the datasets independently revealed that the prevalence of ADHD decreases with increasing altitude (R 2 = .38, p < .001; R 2 = .31, p < .001), respectively. This study controlled for potential confounds (e.g., low birth weight, ethnicity, and household size). Conclusion: These findings suggest a need for further investigation into the extent by which altitude may serve as a protective factor for ADHD.
Objective: The aim of this study was to examine occurrence of emotional lability (EL) in preschoolers with ADHD symptoms versus controls. Method: The study was part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. In the present study, 495 preschoolers were clinically examined. Symptoms of ADHD, anxiety, and oppositional defiant disorder (ODD) were measured with the Preschool Age Psychiatric Assessment Interview. An EL measure was obtained from the Emotional Control subscale of the Behavior Rating Inventory of Executive Function–Preschool Version (BRIEF-P), which parents and teachers completed. Results: EL was significantly more frequent in the ADHD group compared with controls (25% vs. 7%, p < .001). By parent report, EL correlated significantly with ADHD-, anxiety-, and ODD symptoms. By teacher report, EL was significantly correlated only with hyperactivity-impulsivity. Conclusion: EL appears identifiable in young preschoolers and was particularly associated with ODD in children with ADHD symptoms.
Objective: The evidence for central stimulant (CS) treatment in ADHD is strong in some respects but not with respect to unselected clinical material and long-term effects over the life course cycle. The objective of this study was to explore differences in vocational, psychiatric, and social impairment, including crime and substance abuse, among adults with ADHD, treated or not, with CS drugs before age 18. Method: A clinical population of men (N = 343) and women (N = 129) seeking CS treatment as adults was assessed within a specific program for such treatment. Clinical information and data collected by structured instruments were available. Results: Previously CS-treated persons had a lower frequency of problems (alcohol/substance abuse, criminality), and of certain psychiatric disorders (depressive, anxiety and personality ones). Most differences were substantial. Conclusion: The study supports the assumption that CS treatment during childhood/adolescence offers some protection against the development of a range of problems known to characterize adult ADHD patients.
Objective: This study investigated age-related changes in sustained attention in children with ADHD and in their typically developed peers. Method: The study used a Continuous Performance Test (CPT) that includes visual and auditory stimuli serving as distractors. The rate of omission errors was used as a measurement of difficulty in sustained attention. Participants were children and adolescents aged 7 to 18 years (478 with ADHD and 361 without ADHD). Results: Both groups of adolescents (with and without ADHD) showed reduced distractibility than younger children from the same group. However, distractibility tended to diminish in non-ADHD adolescents, but not in adolescents with ADHD. Conclusion: Although part of the difficulties in ADHD could be explained by developmental delay that improves with time, other deficits, such as increased distractibility causing more omission errors, do not show a clear developmental trajectory. The results suggest that deficits in inhibitory control might be the core of ADHD.
Objective: Research results on the nature of sleep problems in children with ADHD are highly inconsistent. It is frequently reported that children with ADHD show more night-to-night variability in sleep than their typically developing (TD) peers, but this finding is also inconsistent. Lack of methodological control may account for these inconsistent findings. The current study examined the night-to-night variability of sleep between TD children and children with ADHD who were rigorously diagnosed, medication naïve, and free from comorbid mental health disorders. Method: Sleep parameters were analyzed for night-to-night variability across 4 weekday nights using actigraphy in 50 children with ADHD and 50 age- and sex-matched TD children. Results: There was a significant night-to-night variability for only sleep duration, but this was similar in both groups. Conclusion: These findings suggest that sleep problems in children with ADHD are not due to greater variability in sleep parameters relative to their TD peers.
Objective: To investigate the genetic contributors to ADHD sustained attention deficit among noradrenergic genes responsible for the synthesis (dopamine-β-hydroxylase gene, DBH), transport (norepinephrine transporter gene, NET1), reception (alpha-2A adrenergic receptor gene, ADRA2A), and metabolism (monoamine oxidase A gene, MAOA) of noradrenalin (NE). Method: A total of 456 children with ADHD and 108 normal controls were included in a digit cancellation test (DCT). DNA was collected from 242 participants and genotyped for 14 single nucleotide polymorphisms (SNPs) of noradrenergic genes. Results: Compared with normal controls, children with ADHD showed a lower total score and higher mean error rate in the DCT, indicating poorer sustained attention function. Analysis of covariance showed an association between MAOA genotypes and ADHD performance in DCT, with poorer performance in risk allele carriers. No association was found for other noradrenergic genes. Conclusion: Children with ADHD presented with a sustained attention deficit compared with normal controls. The sustained attention deficit of children with ADHD may be associated with genetic variant of MAOA.
Objective: The present study aimed to reveal the brain correlates of phonological working memory (WM), dual tasking, and distraction in adult ADHD combined with the effect of polymorphisms of monoamine oxidase A (MAOA rs1137070 Asp470Asp). Method: A total of 29 participants with adult ADHD and 21 controls were recruited. They completed 0-back and 2-back tasks, as wells as 2-back tasks with a dual-task effect or a distracting effect, during functional magnetic resonance imaging scanning. Results: The brain activation of WM in the bilateral inferior frontal lobe, pars opercularis, was higher among the adult ADHD group. The genotype of MAOA significantly interacted with the ADHD effect in the left inferior frontal lobe, pars opercularis. Adults with ADHD had higher activation in the left lingual area in response to the dual-tasking effect. Conclusion: The MAOA polymorphism moderated the altered activation in pars opercularis for WM among adults with ADHD. The higher lingual gyrus activation might indicate that higher attention resources are demanded to sustain the dual-task function of adults with ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Although adolescents with ADHD report less driving experience, a greater proportion of adolescents with ADHD report receiving at least one ticket; however, no study has examined the severity of infractions committed by adolescent drivers with ADHD. Method: A total of 61 adolescents (28 ADHD, 33 controls) aged 16 to 17 with a valid driver’s license completed a self-report Driving History Questionnaire (DHQ), which asked about months of driving experience, negative driving outcomes, and severity of consequences. Results: A greater proportion of adolescents with ADHD reported receiving fines, points on their driver’s license, and remedial driving class. Furthermore, adolescents with ADHD reported attending a greater number of hours in remedial driving class, and a greater expense associated with fines. Conclusion: Importantly, ADHD-related negative driving outcomes manifest early in driving careers. Furthermore, increased negative consequences of poor and/or risky driving among adolescents with ADHD were evident despite having fewer months of independent driving.
Objective: This study investigated biased self-perceptions of academic and social competence among young adolescents with a range of ADHD symptoms. The goal was to better understand how to measure agreement and disagreement between competence ratings from multiple informants. Method: The commonly used discrepancy methodology was used along with polynomial regression/response surface analyses to explore the relationship between biased self-perceptions and ADHD symptoms. Participants were 164 middle school students and their homeroom teachers. Students and teachers completed measures about academic and social competence, and teachers rated ADHD symptoms. Results: Discrepancy score and polynomial regression/response surface analyses both supported the relationship between student overestimation of competence and ADHD symptoms. Response surface analyses also suggest that some students with ADHD symptoms accurately perceive their impairments, particularly in the academic domain. Conclusion: Findings demonstrate the importance of using more advanced methods to understand the relationship between both accurate and discrepant perceptions of competence and ADHD symptoms.
Objective: The objective of this study was to examine the relationships between sleep and attention in both typically developing (TD) children and children with ADHD. Method: The current study examined sleep and attention in 50 children, from 6 to 12 years of age (25 ADHD, 25 TD). Attention was measured using the Conners’ Parent Rating Scale–Revised: Long Version and the Attention Network Test–Interaction (ANT-I), which provided an objective measure of alerting, orienting, and executive attention. Sleep was objectively measured using actigraphy. Results: Children with ADHD had poorer alerting and executive attention on the ANT-I, as well as poorer parent-reported attention. In addition, poor sleep predicted performance on alerting attention for children with ADHD and TD children, whereas the interaction between poor sleep and ADHD diagnosis predicted executive attention scores. Conclusion: The findings of the current study highlight the importance of ensuring children are getting good quality sleep to optimize attention, particularly for children with ADHD.
Objective: This overarching synthesis brings together the findings of four systematic reviews including 138 studies focused on non-pharmacological interventions for ADHD used in school settings. These reviews considered the effectiveness of school-based interventions for ADHD, attitudes toward and experience of school-based interventions for ADHD, and the experience of ADHD in school settings. Method: We developed novel methods to compare the findings across these reviews inductively and deductively. Results: Key contextual issues that may influence the effectiveness and implementation of interventions include the relationships that pupils with ADHD have with their teachers and peers, the attributions individuals make about the etiology of ADHD, and stigma related to ADHD or intervention attendance. Conclusion: Although we found some positive effects for some outcomes and intervention categories, heterogeneity in effect size estimates and research evidence suggests a range of diverse contextual factors potentially moderate the implementation and effectiveness of school-based interventions for ADHD.
Objective: The objective of this study was to examine the efficacy of child cognitive-behavioral therapy (CCBT) versus family CBT (FCBT) in anxiety-disordered youth with high and low comorbid ADHD symptoms. Method: Youth with anxiety disorders (n = 123, aged 8-18) were classified in four groups according to (a) the type of CBT received (child vs. family) and (b) their comorbid ADHD symptoms, measured with the Child Behavior Checklist (CBCL) Attention Problems syndrome scale level (normal vs. [sub]clinical). Severity of anxiety disorders was assessed with Anxiety Disorders Interview Schedule–Child and Parent (ADIS-C/P) version and anxiety symptoms via a 71-item anxiety symptom questionnaire, the Screen for Child Anxiety and Related Emotional Disorders (SCARED-71), before and after CBT, and at 3 months and 1-year follow-ups. Results: Based on the severity of anxiety disorders, children with high ADHD symptoms profit more from FCBT than CCBT in the long term. For children low on ADHD symptoms, and for anxiety symptoms and attention problems, no differences between CCBT and FCBT occurred. Conclusion: Family involvement seems a valuable addition to CBT for children with comorbid anxiety and ADHD symptoms.
Objective: The objective of this study was to examine the prevalence and correlates of self-reported attention deficit disorder (ADD)/ADHD in Canadian adults. Method: Prevalence of self-reported ADD/ADHD was examined in a large national sample of Canadians (n = 16,957). Demographic variables, lifetime, and current psychiatric comorbidities were then compared in a group of adults with self-reported ADD/ADHD (n = 488) and an age- and gender-matched control group (n = 488). Results: The prevalence of self-reported ADD/ADHD was 2.9%. Significantly higher lifetime and current prevalence rates of major depressive disorder, bipolar I and II disorders, generalized anxiety disorder, and substance use disorders were observed in the ADD/ADHD group compared with the control group. Within the ADD/ADHD group, lifetime and 12-month prevalence rates of major depressive disorder and generalized anxiety disorder were significantly higher in women, whereas lifetime and current rates of some substance use disorders were significantly higher in men. Conclusion: In a national sample of Canadian adults, self-reported ADD/ADHD was associated with significant psychiatric comorbidity. Gender differences were also noted.
Objective: Individuals with fragile X syndrome (FXS) present primarily with cognitive and social deficits in addition to symptoms of ADHD. The relationship between symptoms of ADHD, cognitive functioning, and social skills has never been explicitly studied. Method: Here, we analyzed both longitudinal (n = 70; Time 1: ages 6-18; Time 2: ages 15-26) and cross-sectional (n = 73; Time 2 only) data using hierarchical linear regression to assess how global intellectual functioning (IQ) and symptoms of ADHD influence social functioning in individuals with FXS. Results: We found that ADHD symptoms at Times 1 and 2 consistently predict social functioning in both males and females with FXS at Time 2. Conclusion: Our results suggest that addressing ADHD symptoms in childhood may have positive, long-term effects on the social functioning of adolescents and young adults with FXS.
Objective: The objective of this study was to evaluate the relationship between school climate and ADHD medication treatment among adolescents in Medicaid in Georgia. Method: School climate and Medicaid claims data were aggregated for 159 GA counties. County-level school climate percentile and medicated ADHD prevalence were calculated. The t tests and regression models evaluated the relationship between school climate, medicated ADHD, and demographics, weighted by county population. Poorer 2008 school climate (<25th percentile) was regressed on 2011 medicated ADHD prevalence, controlling for potential confounders. Results: The prevalence of medicated ADHD was 7.8% among Medicaid-enrolled GA adolescents. The average county-level prevalence of medicated ADHD was 10.0% (SD = 2.9%). Poorer school climate was associated with lower rates of medicated ADHD (p < .0001); along with demographics, these factors accounted for 50% of the county variation in medicated ADHD. Conclusion: School climate is associated with medicated ADHD among adolescents in Medicaid. Additional research may reveal whether high medicated ADHD may reflect a lack of access to non-pharmacological therapies in some communities.
Objective: The aim of this study was to determine whether the brain-derived neurotrophic factor (BDNF) 196 G/A or catechol-O-methyltransferase (COMT) Val158Met polymorphisms is associated with susceptibility to ADHD. Method: We conducted a meta-analysis of the associations between the BDNF 196 G/A and COMT Val158Met polymorphisms and ADHD. Results: Sixteen studies consisting of 3,594 patients with ADHD and 4,040 controls were included in this meta-analysis. Our results showed no association between ADHD and the BDNF 196A allele in all participants (odds ratio [OR] = 0.958, 95% confidence interval [CI] = [0.800, 1.146], p = .638), European or Asian population. Meta-analysis indicated no association between ADHD and the COMT G allele in all study participants (OR = 1.078, 95% CI = [0.962, 1.207], p = .196), European or Asian population. Conclusion: This meta-analysis showed a lack of association between the BDNF 196 G/A and COMT Val158Met polymorphisms and ADHD.
Objective: To investigate implicit and explicit self-esteem and academic self-evaluation among children with ADHD as a function of parenting styles, namely, authoritarian, authoritative and permissive parenting. Method: Participants included 43 children with ADHD and 35 non-ADHD controls who filled out self-concept and perceived parenting style questionnaires. They also took an Implicit Association Test (IAT) that measured unacknowledged self-esteem. Results: Lower self-esteem was found among children with ADHD than among controls, with stronger effect on the implicit level. Perceived authoritarian parenting was related to lower implicit self-esteem among children with ADHD. Higher self-esteem was found in the authoritative than in the permissive parenting groups in the non-ADHD control group but not among children with ADHD. Conclusion: The role of parental support versus authoritarian parenting in terms of implicit self-esteem points to the importance of promoting responsiveness strategies among parents in the treatment of children with ADHD.
Objective: Individuals with ADHD preferentially choose smaller sooner (SS) over larger later (LL) rewards, termed impulsive choice. This has been observed to different degrees on single-choice and more complex discounting tasks using various types of rewards and durations of delays. There has been no direct comparison of performance of ADHD children using these two paradigms. Method: Two experimental paradigms, single-choice and temporal discounting, each including two delay conditions (13 and 25 s), were administered to 7- to 9-year-old children with ADHD (n = 17) and matched controls (n = 24). Results: Individuals with ADHD chose more SS rewards than controls on both tasks, but in the long delay condition only. Conclusion: These findings demonstrate that delay durations rather than paradigm types determine laboratory-based measures of choice impulsivity in ADHD.
Objective: Comorbid ADHD and substance use disorder (SUD) presents frequently in adolescence, a developmental period that may promote the emergence of substance misuse among individuals with ADHD. Comorbid ADHD and SUD in adolescence results in significant and unique treatment challenges, necessitating examination into effective interventions. Method: This systematic review examined existing research into the treatment of comorbid adolescent ADHD and SUD. Results: Findings from a small number of pharmacological intervention studies suggest potential efficacy of extended-release stimulant and nonstimulant medications. Efficacy of psychotherapeutic interventions has not been systematically examined. Conclusion: Current research on treatments for comorbid ADHD and SUD in adolescence is limited. Future placebo-controlled clinical trials using large samples are needed to examine the efficacy of psychotherapeutic interventions, the heightened risk of prescription stimulant misuse, and the long-term maintenance of treatment gains in this population. Clinical guidelines for the treatment of comorbid ADHD and SUD are discussed.
Objective: Sleep problems are common in children with autism spectrum disorders (ASD) and ADHD and impact adversely on child and parent well-being. The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD–ASD. Method: A subsample of children with ADHD–ASD (n = 61; 5-13 years; 89% male) participating in the Sleeping Sound With ADHD study were included in the current investigation. The subsample comprised of 28 children randomized to the sleep intervention group, while 33 were randomized to usual clinical care. The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and standardized behavioral strategies. Results: Children with ADHD–ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-randomization. Conclusion: These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD–ASD.
Objective: This study examined the effect of a 12-week table tennis exercise on motor skills and executive functions in children with ADHD. Method: Fifteen children with ADHD received the intervention, whereas 15 children with ADHD and 30 typically developing children did not. The Test of Gross Motor Development–2, Stroop, and Wisconsin Card Sorting Test (WCST) were conducted before and after the intervention. Results: After the intervention, the ADHD training group scored significantly higher in the locomotor as well as object-control skills, Stroop Color–Word condition, and WCST total correct performance compared with the ADHD non-training group, and we noted improvements in the locomotor as well as object-control skills, Stroop Color–Word condition, and three aspects of the WCST performances of the ADHD training group over time. Conclusion: A 12-week table tennis exercise may have clinical relevance in motor skills and executive functions of children with ADHD.
Objective: To introduce a revised version of the Weekly Calendar Planning Activity (WCPA) adapted for university students (Weekly Calendar Performance Activity for students [WCPA-S]) and compare the performance of this activity between students with and without ADHD and across gender groups. Method: Participants included a total of 157 students, ages 20 to 30, enrolled in universities/colleges and divided into two groups: students with ADHD (male = 23, female = 38) and without ADHD (male = 33, female = 63). A two-way ANOVA was used for data analyses. The WCPA-S was administered to each student individually. Results: Significant differences were found between students with and without ADHD and across genders in performance, duration of performance, and in the number of strategies used. Conclusion: The WCPA-S proved to be an effective performance-based diagnostic tool for the utilization of executive functions in the daily life of university students. This instrument can be used to predict success in higher education and to support learning among university students with ADHD.
Objective: The purpose of this study was to investigate the possibility of creating a new scale on the Personality Assessment Inventory (PAI) to assess for ADHD-like symptomatology. Method: Two approaches to scale development were compared: (a) stepwise regression using PAI scales and subscales as predictors and the CAARS-H index as the dependent variable and (b) a MANOVA using discharge diagnosis as the grouping variable and PAI scales and subscales as the dependent variables. Results: Stepwise regression identified six PAI scales and subscales (PIM, RXR, SOM-S, ARD-T, MAN-A, and SCZ-T) that were responsible for a large proportion of variance (39%) in the CAARS-H index, and the MANOVA also identified six subscales that significantly differed between those clients eventually diagnosed with ADHD and those not diagnosed (ANT-S, SCZ-T, MAN-A, ANX-C, BOR-S, and MAN-G). Conclusion: Although each set produced statistically significant findings, neither produced high correct classification rates in the eventual diagnosis of ADHD.
Objective: To examine different risk factors between disruptive behavior disorders (DBD) and ADHD or combined DBD and ADHD. Method: The study population was derived from the Northern Finland Birth Cohort 1986. Psychiatric diagnoses were defined from the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL) interview. The study sample was divided into four groups—people with DBD (n = 44), with ADHD (n = 91), with both (n = 72), and without either (n = 250)—to evaluate the different risk factors behind these disorders. Results: After adjusting with possible confounding factors, female gender and paternal admittance to inpatient psychiatric care increased the odds that an adolescent was having DBD. Childhood hyperactivity symptoms increased the odds of having ADHD and childhood hyperactivity symptoms and scholastic impairment increased the odds of having both disorders. Conclusion: Our study indicates DBD and ADHD have clearly different risk factors, and the impact of the paternal factors on DBD should be noted more than has been before.
Objective: Maternal functioning differences in parenting stress, parental efficacy, and parenting behaviors were examined for mothers of children with ADHD. Method: Participants included 29 mothers of children with ADHD, Predominantly Inattentive Type (ADHD-I) and 38 mothers of children with ADHD, Predominantly Hyperactive-Impulsive or Combined Type (ADHD-HI/C). Results: Findings suggest that mothers of children with ADHD-HI/C reported significantly greater parenting stress and engaged in more negative parenting behaviors than mothers of children with ADHD-I. Conclusion: This study suggests that tailoring behavioral parent training based on ADHD subtype may be particularly helpful for parents of children with ADHD-HI/C.
Objective: The aim of this study was to synthesize published data regarding long-term effects of ADHD on information learned (measured via achievement tests) and success within the school environment (academic performance). Method: A systematic search identified 176 studies (1980-2012) of long-term (≥2 years) academic outcomes with ADHD. Results: Achievement test outcomes (79%) and academic performance outcomes (75%) were worse in individuals with untreated ADHD compared with non-ADHD controls, also when IQ difference was controlled (72% and 81%, respectively). Improvement in both outcome groups was associated with treatment, more often for achievement test scores (79%) than academic performance (42%), also when IQ was controlled (100% and 57%, respectively). More achievement test and academic performance outcomes improved with multimodal (100% and 67%, respectively) than pharmacological (75% and 33%) or non-pharmacological (75% and 50%) treatment alone. Conclusion: ADHD adversely affects long-term academic outcomes. A greater proportion of achievement test outcomes improved with treatment compared with academic performance. Both improved most consistently with multimodal treatment.
Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Before-School Functioning Questionnaire (BSFQ) as a measure of morning behaviors impaired by ADHD. Method: We used pre-treatment data from a randomized crossover study of 6- to 12-year-old participants comparing the methylphenidate transdermal delivery system (MTS) with a placebo transdermal system (PTS) for a total of 4 weeks. Results: The BSFQ investigator–rated scale shows very good internal homogeneity (Cronbach’s α = .91), good test–retest reliability (r = .60), good concurrent validity (r range = .42-.86), and a strong treatment effect (effect size = –.93). The self-rated BSFQ showed lower levels of reliability and validity. Conclusion: The investigator-rated BSFQ should be used in future trials of ADHD medications aimed at assessing efficacy in the morning before school.
Objective: Previous research in clinical samples indicated a significant association between ADHD and restless legs syndrome (RLS). The present study examined the association between adult ADHD and RLS in the German population. Method: Self-rating instruments to assess RLS, childhood ADHD, and adult ADHD were administered to a community-based sample (N = 1,632). In addition, current depression and anxiety, sleep disturbances, weight, and height were assessed by self-report. Results: Adult ADHD was associated with statistically significant increases in the odds of meeting diagnostic criteria for RLS even when adjusting for potential confounding variables such as weight (odds ratio [OR] = 3.18, 95% confidence interval [CI] = [1.29, 7.63], p< .001). However, the association did not hold true after adjusting for the presence of sleep disturbances (OR = 2.02, 95% CI = [0.82, 4.96], p = .13). Conclusion: The findings suggest a strong link between RLS and adult ADHD symptoms. Clinicians should be aware of RLS among adult ADHD patients, especially as there might be a negative interactive effect.
Objective: For children with high levels of ADHD symptoms, to investigate the impact of early school-based interventions on academic outcomes in mid-childhood. Method: A 6-year follow-up of 4- to 5-year-olds (N = 52,075) whose schools participated in a cluster randomized controlled trial for children at risk of ADHD. School-level interventions involved the provision of a booklet with evidence-based information (book) and/or feedback of names (identification) of children with high levels of ADHD symptoms. At ages 10 to 11 years, outcome measures were scores in English and mathematics tests. Results: For children with high levels of ADHD symptoms, the interventions had no impact on academic outcomes. When all children were analyzed, the book intervention had a positive impact on mathematics. Baseline inattention was associated with poorer academic outcomes, whereas impulsiveness was associated with better academic outcomes. Conclusion: The provision of evidence-based information about helping children with ADHD at school may have wider academic benefits.
Objective: To use a multi-method approach to examine the association of parental ADHD and gender with observed and self-reported parenting beliefs and behaviors. Method: Seventy-nine mother–father dyads completed measures of child behavior and impairment, parenting beliefs and behaviors, and self- and partner ratings of ADHD symptoms and functional impairment. Forty-five parents also completed structured parent–child interactions. Results: A hierarchical linear model suggests impairment in functional domains may be associated with negative emotions about parenting and less effective parenting strategies. For fathers, greater severity of partner-reported symptoms of ADHD may be associated with greater frequency of negative talk during parent–child interactions. Conclusion: Findings suggest that higher levels of parental ADHD symptoms and functional impairment may be associated with reported beliefs and behaviors related to parenting. Differences emerged among mothers’ and fathers’ use of parenting strategies when self- and other-report of ADHD symptoms and impairment were assessed.
Objective: Problems related to executive function (EF) are frequently reported in adults with ADHD. However, only a subgroup of patients show deficits on common neuropsychological tests designed to measure EF. We investigated whether this subgroup also had higher levels of functional impairments, including unemployment, than the ADHD group without such deficits. Method: We defined executive function deficit (EFD) from selected tests from the Delis–Kaplan Executive Function System (D-KEFS) and assessed ADHD symptoms and psychiatric comorbidity with the use of questionnaires in 79 ADHD patients and 77 controls (IQ above 80 in both groups). Results: In the ADHD group, 24.3% had EFD. This subgroup showed significantly higher frequency of unemployment, more reading and writing problems, lower IQ scores, and more self-reported ADHD symptoms in childhood than the ADHD subgroup without EFD. Conclusion: These findings indicate that it may be possible to identify individuals at risk of functional impairments, and emphasizes the importance of effective treatment programs targeting EF.
Objective: To examine how ADHD evaluations are documented for postsecondary students requesting disability eligibility. Method: A total of 100 psychological reports submitted for eligibility determination were coded for documentation of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, methods and instruments used in the evaluations, and recommended academic accommodations. Results: Results showed that a minimal number of reports (≤1%) documented that students met all DSM criteria for ADHD. Psychologists rarely documented childhood impairment, symptoms across settings, or the use of rule-outs. Symptom severity was emphasized over current impairment. The majority of psychologists utilized a multi-informant, multi-method evaluation approach, but certain methods (e.g., symptom validity tests, record reviews) were limited in use. Most reports included recommendations for academic accommodations, with extended time being the most common (72%). Conclusion: This study raises awareness to the aspects of adequate ADHD evaluation and subsequent documentation that can be improved by psychologists. Recommendations are made regarding valid documentation of ADHD for disability determination purposes.
Objective: The main aim of the current study was to investigate the links between ADHD diagnosis and the objective and subjective dimensions of social relationships among children from primary schools. Method: We used the data from 36 regular classrooms, consisting of 718 students, with each containing at least one child with an established clinical diagnosis of ADHD (38 children). Results: For children with ADHD, the level of the perceived quality of social relations was lower than that of children without such a diagnosis. After controlling for sociometric status, the impact of ADHD on perceived status proved to be statistically nonsignificant but the indirect impact of ADHD on this status through sociometric status was statistically significant. Conclusion: Children diagnosed with ADHD are more often rejected by their peers and have a more pessimistic view of their social world. Moreover, ADHD diagnosis does not have a direct influence on the perceived quality of social relations otherwise than through sociometric status.
Objective: To investigate the care management and continuity from child to adult mental health service for young adults with ADHD. Method: A questionnaire survey from 18 Regional ADHD Pediatric Centers (RAPC) in Lombardy, Italy, was used to collect data on transition protocols and population served, and to track the pathway of care of ADHD patients once they reached adulthood. Results: Twenty-eight percent of RAPC had transition protocols and 3% of the population annually served were potential referrals to adult service. Of 52 patients who turned 18 years, just over 70% were monitored by the general practitioner, of those 5 with RAPC support. One fifth of patients continued to use mental health services, the majority was still monitored by the RAPC, and only three by services for adult. Conclusion: Managing the process of transition to adult services in mental health care remains a need to be prioritized and better defined for ADHD patients.
Objective: Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers’ personality traits and own ADHD symptoms could also affect parenting stress. Method: 430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers’ group and maternal personality/ADHD symptoms related to parenting stress. Results: Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers’ group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers. Conclusion: Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.
Objective: This study examined the prevalence and correlates of anxiety disorders in Chinese children with ADHD. Method: Overall, 120 children with ADHD aged 6 to 12 years were recruited, and the parent version of computerized Diagnostic Interview Schedule for Children–Version 4 was administrated to their primary caretakers. Results: The prevalence rate of anxiety disorders was 27.5%, which is consistent with the reports of previous Asian and Western studies. Among the children with ADHD and anxiety disorders, more than 50% of them also had comorbid oppositional defiant disorder or conduct disorder (ODD/CD), which yielded an adjusted odds ratio of 3.0 in multivariable analysis for anxiety disorder, with comorbid ODD/CD. In addition, anxiety disorders were positively associated with inattention symptoms in children with both disorders. Conclusion: Clinicians should perform screening and careful assessment for anxiety symptoms in children with ADHD, particularly those suffering from comorbid ODD/CD.
Objective: Children with fetal alcohol spectrum disorder (FASD) can easily be misdiagnosed as having ADHD. Method: A total of 164 children were compared on cognitive and behavioral measures for four groups of children: FASD, ADHD, FASD + ADHD, and other neuropsychological disorders. Results: The ADHD group was not significantly different from the "other diagnosis" group on any of the measurements. The children with FASD were found to perform significantly worse than ADHD on externalizing problems, Full-Scale IQ, and indices of Verbal Comprehension, Perceptual Reasoning, and Working Memory. The comorbid FASD + ADHD group was significantly weaker than ADHD on verbal comprehension measures. The FASD children demonstrated significantly higher levels of atypicality and aggression relative to ADHD, and the FASD + ADHD group demonstrated significantly higher levels of hyperactivity and withdrawal relative to ADHD. Conclusion: These results indicate that children with FASD display a differential behavioral and cognitive profile that is significantly poorer than children with ADHD and other types of neuropsychological disorders.
Objective: The present study utilized ecological momentary assessment (EMA) to examine the effects of emotional impulsivity on overall functional impairment and functional impairment variability (FIV) of children with and without ADHD. Method: Parents of 74 children, 8- to 12-year-olds (42 with ADHD, 32 without ADHD), completed EMA assessment protocol ratings of their child’s mood (3 times daily) and functional impairment (1 time daily) over the course of 28 days. Results: Hierarchical regression analyses supported the interaction of ADHD diagnostic status and greater EMA-derived emotional impulsivity in the estimation of total functional impairment (Total FI) and FIV. Thus, greater emotional impulsivity was found to be related to greater Total FI and FIV among children with ADHD but not among children without ADHD. Conclusion: This study suggests that children with ADHD and greater emotional impulsivity demonstrate greater overall levels of functional impairment, with the severity of their impairment varying significantly over time.
Objective: This study examined ADHD and sluggish cognitive tempo (SCT) symptoms in relation to self-report and laboratory measures of neuropsychological functioning in college students. Method: College students (N = 298, aged 17-25, 72% female) completed self-reports of ADHD, SCT, depression, sleep, functional impairment, and executive functioning (EF). Participants also completed a visual working memory task, a Stroop test, and the Conners’ Continuous Performance Test–II (CPT-II). Results: ADHD inattentive and SCT symptoms were strong predictors of self-reported EF, with inattention the strongest predictor of Time Management and Motivation and SCT the strongest predictor of Self-Organization/Problem Solving. SCT (but not inattention) was associated with Emotion Regulation. No relationships were found between self-reported symptoms and laboratory task performance. Between-group analyses were largely consistent with regression analyses. Conclusion: Self-reported ADHD and SCT symptoms are strongly associated with college students’ self-reported EF, but relationships with laboratory task measures of neuropsychological functioning are limited.
Objective: This study investigates the relationship between ADHD and the personalities of parents of children with ADHD. Method: Personality traits of parents of children with ADHD (study group; n = 135) and parents of children without ADHD (control group; n = 122) were compared. Psychiatric comorbidities were excluded with Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version [SCID-I-CV]. Personality is assessed with Temperament and Character Inventory, and inattention (IA) and hyperactivity (HI) are assessed with Turgay Scale. Results: Harm avoidance and persistence scores were higher, and self-directedness (SD) scores were lower in the study group than the control group. Being in ADHD group predicted lower SD scores. Positive correlations were found between harm avoidance and IA and HI, and between persistence and HI. Negative correlations were found between SD and both IA and HI. Conclusion: Our data suggest that there is relationship between ADHD in children’s and parents’ personalities. Common etiologic properties and personalized psychoeducation and treatment options for families should be discussed.
Objective: To examine the screening ability of the Strengths and Difficulties Questionnaire (SDQ) for ADHD subtypes in a clinical sample. Method: Parents of 523 children (3 to 17 years old) referred to Child and Adolescent Mental Health Services completed the Spanish version of the SDQ and the ADHD Rating Scale–IV. Receiver operating curve (ROC) curve analyses and likelihood ratios (LRs) were conducted. Results: The LR results indicated that the 8/10 cutoff showed the highest diagnostic accuracy. The sensitivity of the SDQ 8/10 cutoff for the three subtypes was significantly different: 84.0% (95% confidence interval [CI] = [75.58, 89.90]) of ADHD combined subtype (ADHD-Co), 25.0% (95% CI = [17.55, 34.30]) of ADHD predominantly inattentive subtype (ADHD-I), and 77.8% (95% CI = [68.71, 84.83]) of ADHD predominantly hyperactive/impulsive subtype (ADHD-H). Sex and age differences were found. These screening differences were also found when using the 7/10 cutoff or the SDQ predictive algorithm. Conclusion: Our study supports the use of the SDQ in the screening for ADHD. However, not all ADHD subtypes are equally screened.
Objective: The aim of this study was to evaluate whether a shortened-length session of CogMed Working Memory Training (CWMT) would be a suitable active control group and evaluate study protocol to aid in design refinements for a larger randomized controlled trial (RCT). Method: Thirty-eight post-secondary students diagnosed with ADHD were randomized into 25 sessions of standard (45 min/session) or shortened (15 min/session) CWMT, or into a waitlist control group. Results: There was no significant difference in completion rate or training index score between the standard- and shortened-length groups indicating that both groups showed improvement and put forth good effort during training. Conclusion: Preliminary findings suggest that shorter training sessions may induce similar levels of engagement, motivation, and expectancy of improvement in participants. We conclude that a larger scale RCT that utilizes shortened-length training as an active control group is warranted, but that a few modifications to the study protocol will be required.
Objective: To evaluate the long-term effects of methylphenidate imediate-release (MPH-IR), and to confirm the efficacy established in previous meta-analyses of short-term studies. Method: Published and unpublished studies in which participants were treated with MPH-IR for 12 weeks or more were searched. Pooled effect sizes from these studies were computed with the DerSimonian and Laird random-effect model. Meta-regression analysis was conducted to estimate covariates associated with treatment effects. Results: Seven studies were included. Pooled parents ratings for inattention and hyperactivity/impulsivity resulted in standardized mean difference (SMD) = 0.96 (95% confidence interval [CI] = [0.60, 1.32]) and SMD = 1.12 (95% CI = [0.85, 1.39]), respectively; pooled teachers ratings showed SMD = 0.98 (95% CI = [0.09, 1.86]) for inattention and SMD = 1.25 (95% CI = [0.7, 1.81]) for hyperactivity/impulsivity. No evidence of association of any covariates with treatment effect was detected in the meta-regression. Conclusion: MPH-IR is efficacious for childhood ADHD for periods longer than 12 weeks.
Objective: The purpose of this study was to compare groups of children with two subtypes of ADHD and controls on selected regions using volumetric magnetic resonance imaging (MRI) measures. Children with ADHD were expected to have smaller volumes of the anterior cingulate cortex (ACC) and caudate. Parent behavioral rating measures of hyperactivity were predicted to relate to the volume of the caudate and attention with the ACC. Method: There were a total of 74 children in the final sample (27 controls, 25 ADHD:Combined type [ADHD:C], 22 ADHD:Inattentive type [ADHD:I]). Results: Findings indicated that the ADHD:C group had bilaterally smaller volumes of the caudate and ACC compared with the other two groups. In addition, parent ratings of attention and hyperactivity significantly predicted the right volume of the ACC, whereas hyperactivity ratings predicted the volume of the right caudate. Analysis of the ADHD groups without the control confirmed these findings. Conclusion: These findings indicate that different structures are related to the ADHD subtypes and suggest that they may be different phenotypes.
Objectives: To examine the performance on the Deese-Roediger-McDermott task of adults divided into ADHD subtypes and compares their performance to that of healthy controls to examine whether adults with ADHD are more susceptible to the production of false memories under experimental conditions. Method: A total of 128 adults with ADHD (50% females), classified into three Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV-TR) subtypes, were compared with 48 controls. Results: The results indicated that the ADHD participants recalled and recognized fewer studied words than the controls, the ADHD groups produced more false memories than the control group, no differences in either the false positives or the false negatives. The ADHD–combined (ADHD-CT) group recognized significantly more critical words than the control, ADHD–predominantly inattentive (ADHD-IA), and ADHD–predominantly hyperactive-impulsive (ADHD-HI) groups. The ADHD groups recalled and recognized more false positives, were more confident in their false responses, and displayed more knowledge corruption than the controls. The ADHD-CT group recalled and recognized more false positives than the other ADHD groups. Conclusion: The adults with ADHD have more false memories than the controls and that false memory formation varied with the ADHD subtypes.
Objective: This study examined whether exposure to maternal smoking during pregnancy in children with and without ADHD is associated with smoking in offspring and whether this association is selective to ADHD children. Method: Ninety-six exposed and 400 unexposed participants were derived from two longitudinal studies of boys and girls with and without ADHD. Maternal smoking during pregnancy was defined by interviews with participants’ mothers. Results: A significant association was observed between exposure to maternal smoking in pregnancy and cigarette smoking in offspring (p = .02). Exposed offspring were also more likely to have higher rates of major depression (p = .04), bipolar disorder (p = .04), and conduct disorder (p = .04), and lower IQ (p = .01), lower Global Assessment of Functioning (GAF) score (p = .02), and more impaired Social Adjustment Inventory for Children and Adolescents (SAICA) scores versus unexposed offspring, adjusting for social class. Conclusion: Maternal smoking during pregnancy was found to increase the risk for smoking and a wide range of adverse psychiatric, cognitive, and functional outcomes in youth.
Objective: Provide data on the distribution of parent- and teacher-reported symptoms of ADHD in childhood epilepsy and describe coexisting cognitive and behavioral disorders in children with both epilepsy and ADHD. Method: Eighty-five (74% of those eligible) children (5-15 years) in a population-based sample with active epilepsy underwent psychological assessment. The ADHD Rating Scale–IV (ADHD-RS-IV) scale was completed by parents (n = 69) and teachers (n = 67) of participating children with an IQ > 34. ADHD was diagnosed with respect to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Results: Parents reported significantly more symptoms of ADHD than teachers (p < .001). Symptoms of inattention were more commonly reported than symptoms of hyperactivity-impulsivity (p < .001). Neurobehavioral comorbidity was similar in those with ADHD and non-ADHD with the exception of oppositional defiant disorder (ODD) and developmental coordination disorder (DCD), which were more common in those with both epilepsy and ADHD. Conclusion: Symptoms of ADHD are very common in childhood epilepsy but prevalence is influenced by informant.
Objective: ADHD is no longer considered a disorder that children simply outgrow. Adults experience ADHD at high rates (2.5%-5%) and are impaired in multiple life domains, including social impairment. The purpose of this study was to examine emerging adults with varying degrees of ADHD symptomology in respect to social impairment, state and trait anger, romantic relationship satisfaction, and intimate partner violence (IPV). Method: College students, a subset of emerging adults, were recruited to complete measures online. Results: Data were analyzed using a series of multiple regressions. Higher levels of ADHD symptomology in college students were related to increased social impairment and higher levels of state and trait anger, but not romantic relationship satisfaction or rates of IPV. Conclusion: Anger management and social skills training may be beneficial treatment components for this group.
Objective: To examine the prevalence rates of bullying involvement and their correlates in adolescents diagnosed with ADHD in Taiwan. Method: Bullying involvement, family and ADHD characteristics, the levels of behavioral inhibition system (BIS) and behavioral approach system (BAS), and psychiatric comorbidity were assessed in 287 adolescents with ADHD. The multiple regression analysis was used to examine the correlate of bullying victimization and perpetration. Results: The prevalence rates of the pure victims, pure perpetrators, and victim-perpetrators were 14.6%, 8.4%, and 5.6%, respectively. Young age, a high BIS score, autism spectrum disorders, and low satisfaction with family relationships were associated with severe bullying victimization. A high score of fun seeking on the BAS and low satisfaction with family relationships were associated with severe bullying perpetration. Conclusion: A high proportion of adolescents with ADHD are involved in bullying. Multiple factors are associated with bullying involvement in adolescents with ADHD.
Objective: Excessive alcohol consumption increases risk of perpetrating intimate partner violence (IPV). ADHD is associated with problematic drinking and IPV, but it is unclear whether problem drinkers with ADHD are more likely than those without ADHD to perpetrate IPV. Method: We compared the strength of association between problem drinking trajectories and IPV perpetration among 19- to 24-year-old men with (n = 241) and without (n = 180) childhood ADHD. Results: Men with ADHD who reported higher heavy episodic drinking or alcohol use problems at age 19, and slower decreases in alcohol use problems from age 19 to 24, were more likely to perpetrate IPV than problem drinkers without ADHD, among whom the same associations were non-significant. Associations between problem drinking and IPV were not attenuated in adults with ADHD upon controlling for antisocial personality disorder. Conclusion: Study findings highlight the heightened risk of problem drinkers with ADHD perpetrating IPV.
Objective: To evaluate children with ADHD and sleep problems with polysomnography (PSG) after guanfacine extended-release (GXR) administration. Method: Double-blind, randomized, placebo-controlled study was terminated early due to treatment-emergent concerns after enrolling 29 children aged 6 to 12 years. After >4 weeks dose adjustment and >1 week dose stabilization, 11 children received GXR and 16 controls underwent analyses with PSG. Results: Although GXR improved ADHD symptoms, the primary outcome variable, total sleep time, was shorter in contrast to placebo (–57.32, SD = 89.17 vs. +31.32, SD = 59.54 min, p = .005). Increased time awake after sleep onset per hour of sleep was the primary factor for the reduction. Although rapid eye movement (REM), non-REM, and N3/slow wave sleep times were reduced, these were proportional to the overall sleep reduction. Sedation was common with GXR (73% vs. 6%). Conclusion: Morning-administered GXR resulted in decreased sleep and may contribute to sedation.
Objective: The objective of this study was to describe the epidemiology of diagnosed ADHD and the pharmacological treatment of patients with ADHD in Sweden. Specifically, this study estimates the prevalence of patients with a newly registered diagnosis of ADHD over a 5-year period, and the prevalence of all patients with a registered ADHD diagnoses over a 6-year period in Sweden. Method: Two population-based registries were used as data sources for this study; the National Patient Register (NPR) and the Prescribed Drug Register (PDR). The international Classification of Diseases 10th Revison (ICD-10) was used to identify patients with ADHD. Results: The annual prevalence of ADHD in the general population of Sweden was found to be 1.1 per 1,000 persons in the year 2006 increasing to 4.8 per 1,000 persons in 2011. The corresponding prevalence for newly diagnosed patients increased from 0.6 per 1,000 persons in 2007 to 1.3 per 1,000 persons in 2011. The majority of diagnosed patients received pharmacological treatment, with methylphenidate being the most common dispensed drug. Comorbidities in the autism spectrum were most common for younger patients, while substance abuse, anxiety, and personality disorder were the most common comorbidities in older patients. Conclusion: From 2006 to 2011, the number of patients diagnosed with ADHD has increased in Sweden over all ages. The majority of patients diagnosed with ADHD in Sweden received a pharmacological treatment regardless of age. An ADHD diagnosis was often accompanied with psychiatric comorbidity.
Objective: This study attempted to determine whether the effects of physical exercise were reflected in the resting electroencephalographic (EEG) pattern of ADHD children. Method: Thirty-two ADHD children were assigned to either an exercise group or a control group. The exercise group participated in a water aerobics program for 8 weeks, whereas no intervention was administered to the control group. Resting EEGs were recorded under open-eyes condition before and after the intervention. Data from eligible participants, 15 from the exercise group (11 boys and 4 girls, 7.93 ± 1.02 years) and 14 from the control group (14 boys, 8.27 ± 1.04 years), were further analyzed. Results: While controlling for the baseline resting EEG, separate ANCOVAs indicated that the exercise group showed smaller theta/alpha ratios over the frontal and central brain sites after the intervention compared with the control group. Conclusion: This finding suggests that aerobic exercise may enhance the cognitive functions of children with ADHD, as reflected in resting EEG.
Objective: To evaluate and compare the performance of adults with ADHD with high and standard IQ in executive functions (EF) tasks. Method: We investigated the neuropsychological performance of 51 adults with ADHD, compared with 33 healthy controls (HC) while performing a wide battery of neuropsychological tests that measure executive functioning. Adults with clinical diagnosis of ADHD were divided into two groups according to their IQ level (IQ ≥ 110—ADHD group with more elevated IQ, and IQ < 110—ADHD group with standard IQ). Results: The ADHD group with standard IQ presented a worse executive functioning compared with the HC group in the following measures: Stroop 2 (p = .000) and 3 (p = .000), Trail Making Test (TMT) B (p = .005), Wisconsin Card-Sorting Test (WCST)—perseverative errors (p = .022) and failures to maintain set (p = .020), Continuous Performance Test (CPT)—omission errors (p = .005) and commission errors (p = .000), and Frontal Assessment Battery (FAB)—conceptualization (p = .016). The ADHD group with more elevated IQ presented only impairments in the CPT—commission errors (p = .019) when compared with the control group. Conclusion: Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.
Objective: This study investigated the relationships between ADHD symptomatology and friendship formation, social skills, and the quality of specific friendships in college students. Method: A total of 156 students, 75 of whom had high self-reported ADHD symptomatology, participated. Friends of 68 participants completed measures of friendship quality. Results: Students had more positive first impressions of and reported being friends with others whose ADHD symptom severity matched their own. Participants with high ADHD symptoms reported greater difficulty providing emotional support and managing interpersonal conflict than their low-symptom peers. Greater ADHD symptoms in participants and friends were related to reduced quality of specific relationships, but similarity of severity of symptomatology in the dyad benefited the relationship. Conclusion: These findings have implications for the kind of support offered to students with high ADHD symptomatology when they transition to college. Future longitudinal research examining relationships of varying levels of closeness should be conducted.
Objective: There is a lack of empirically supported treatments for college students with ADHD and academic deficits. The current study evaluated self-monitoring, an intervention that may improve academics in children with ADHD, with a college sample diagnosed with ADHD. Method: Fifty-three participants were recruited, 41 of which completed the study and are included in the analyses. Participants were randomly assigned to a group that received study skills instruction, goal setting, and self-monitoring instruction (SM+ group; n = 22) or a group that received only study skills and goal setting (SM– group; n = 19). Results: Participants in the SM+ group demonstrated significant improvement in their ADHD symptoms, academic behavior, grade point averages (GPAs), and goal attainment. These improvements were not significant for the SM– group. Conclusion: These findings suggest that self-monitoring might be used to improve academic performance in college students with ADHD.
Objective: To compare a novel "third wave" mindfulness-based training program with an established skills training derived from dialectical behavior therapy, to reduce ADHD symptoms and improve mindfulness and self-efficacy. Method: Ninety-one adults with ADHD (combined and inattentive type, mainly medicated) were non-randomly assigned to and treated within a mindfulness-based training group (MBTG, n = 39) or a skills training group (STG, n = 52), each performed in 13 weekly 2-hr sessions. Results: General linear models with repeated measures revealed that both programs resulted in a similar reduction of ADHD symptoms, and improvement of mindfulness and self-efficacy. However, the effect sizes were in the small-to-medium range. A decrease in ADHD symptoms ≥30% was observed in 30.8% of the MBTG participants and 11.5% of the STG participants. Conclusion: The comparatively weak results may be due to limitations such as the absence of randomization, the lack of a control group without intervention, and the lack of matching groups for borderline, depression, and anxiety status. Moreover, audio instructions for home exercises and more stringent monitoring of participants’ progress and eventual absence from sessions might have improved the outcome.
Objective: In an effort to reduce disparities in ADHD diagnoses and treatment across cultures, the current study sought to establish initial psychometric and cultural properties of the ADHD-FX: a culturally sensitive assessment measure of functional impairment related to ADHD for diverse families. Method: Fifty-four Latino parents (44 mothers and 10 fathers) of school-aged children completed the ADHD-FX, as well as several other measures assessing child behavior and parent acculturation. Results: The ADHD-FX demonstrated adequate reliability (as demonstrated by internal consistency and test–retest reliability), psychometric construct validity (as demonstrated by associations with theoretically related measures), and cultural validity (as demonstrated by or lack of associations with acculturation measures). Conclusion: Initial psychometric and cultural properties suggest that the ADHD-FX is a reliable, valid, and culturally appropriate measure to assess functional impairment related to ADHD (i.e., difficulties with academic achievement, social competence, and familial relationships) in an at-risk, school-aged population.
Objective: To evaluate the structural validity of the Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV). Method: Confirmatory factor analyses were applied to a sample of 233 students diagnosed with ADHD by school multidisciplinary evaluation teams to evaluate the relative fit of the following competing models: (a) one factor, (b) two oblique verbal and nonverbal factors, (c) three oblique verbal, perceptual, and combined working memory/processing speed factors, (d) four oblique verbal, perceptual, working memory, and processing speed factors, (e) a higher-order model with four first-order factors, and (f) a bifactor model with four domain-specific factors. Results: A higher-order four-factor model fit the data best, which was composed of a general intelligence factor and four domain-specific factors that matched the four factors specified in the WISC-IV technical and interpretive manual. Moreover, the general intelligence factor explained more than two times the total variance contributed by all four domain-specific factors combined. Conclusions: Results substantiate previous research on the WISC-IV, indicating that the general intelligence factor contributes the most reliable information. Consequently, it is recommended that interpretation of the WISC-IV remain at the Full-Scale IQ score level.
Objective: This study was designed to explore physical, social/behavioral, and mental health factors among incoming university students with elevated self-reported ADHD symptoms. Method: A total of 5,240 incoming university students were recruited. The test battery included the ADHD Self-Report Scale, the Measurement of Support Functions, the Chinese Internet Addiction Scale–Revision, Quality of Life assessment, the Brief Symptoms Rating Scale, and the 10-item Social Desirability Scale. Results: ADHD symptoms were elevated in 8.6% of the sample. Only individuals with a lower social desirability score, however, were recruited for further analysis. Significant influential factors for higher self-reported levels for ADHD symptoms included greater suicidal ideation and emotional disturbance, as well as a higher Internet addiction tendency, lower levels of social support, and a greater amount of exercise. Conclusion: Given the elevated prevalence of self-reported ADHD symptoms among this sample of university students, screening for these kinds of problems to detect early challenges before students fail in college as well as identify youth with undiagnosed ADHD should be considered.
Objective: To examine the performance differences on the Test of Variables of Attention (TOVA) among different IQ level groups. Method: The present study examined the results of the TOVA with 138 elementary students aged 6 to 10 years who were assigned to one of four different groups based on their scores from the Wechsler Nonverbal Scale of Ability (WNV; low average: IQ < 90, average: IQ between 90 and 109, high average: IQ between 110 and 119, superior: IQ between 120 and 129, and very superior: IQ > 129). The latter two groups were combined. Results: On all TOVA measures (response time, response time variability, errors of omission and commission, and ADHD scores), intellectual functioning significantly influenced performance. Conclusion: The results of the present study indicate that performance on the TOVA was affected by intellectual functioning.
Objective: The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). Method: Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Results: TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I. Conclusion: Paired BRIEF scales dissociated EF problems in children with TS from children with ADHD-C, ADHD-I, or ASD. Clinical relevance is discussed.
Objective: People with autism spectrum disorders (ASD) often have comorbid ADHD symptoms. ASD and ADHD are both associated with high intrauterine testosterone (T) levels. This study aims to investigate whether masculinization predicts inattention symptoms in parents, and in their ASD-affected offspring. Method: The sample consisted of 32 parents with ASD-affected children (13 male, 19 female) and 32 offspring individuals (28 male, 4 female). Masculinization of parents was measured by 2D:4D finger ratio, and current T levels. Inattention in both parents and in their offspring was measured with behavior questionnaires. Results: The results indicated that masculinized 2D:4D explains inattentive ADHD symptoms in ASD parents and in their offspring. These predictions are mediated by T and inattention symptoms of ASD parents, respectively. Conclusion: These findings suggest the existence of a masculinized endophenotype in ASD parents, which may be characterized by high attentional sensitivity to T effects.
Objective: This study longitudinally evaluated whether parent-ratings and self-ratings of executive function (EF) predicted the academic and overall functioning of college students with ADHD and whether EF deficits mediated the relationship between ADHD symptoms and functioning. Method: A prospective longitudinal study of 59 college students comprehensively diagnosed with ADHD and their parents who completed ratings at the beginning and end of the school year. Results: Student-rated motivation and parent-rated emotion regulation significantly predicted overall impairment above and beyond symptoms of ADHD. Student-rated EF motivation mediated the relationship between ADHD symptoms and overall impairment. Student-rated EF organization mediated the relationship between ADHD symptoms and end of the year grades. Conclusion: Motivation and organization aspects of EF appear particularly important for functioning. However, given the study’s modest sample size, additional longitudinal research is needed to confirm these findings and to develop best-practice assessment and treatment recommendations for college students with ADHD.
Objective: The purpose of the current study is to examine the utility of the Personality Assessment Inventory (PAI) for detecting feigned ADHD in college students. Method: A sample of 238 undergraduate students was recruited and asked to simulate ADHD (ADHD simulators) or respond honestly (controls) on the PAI. Archival data (n = 541) from individuals diagnosed with clinical ADHD, no diagnosis, learning disorder, mood/anxiety, comorbid ADHD-mood/anxiety, or suspect effort were used. Results: Few individuals scored above the cutoffs on PAI validity scales. When alternative cutoff scores were examined, cutoffs of ≥77 on the Negative Impression Management (NIM) scale, ≥3 on the Malingering Index (MAL), and ≥1 on the Rogers Discriminant Function (RDF) yielded excellent specificity in all groups and sensitivities of .33, .30, and .20, respectively. Conclusion: Individuals who were asked to simulate ADHD easily manipulate the PAI; however, alternative cutoff scores proposed for PAI validity indices may improve the detection of feigned ADHD symptoms.
Objective: Few studies have examined whether separate dimensions of Sluggish Cognitive Tempo (SCT)—inconsistent alertness and slowness—have different external correlates from each other as well as symptoms of ADHD inattention (ADHD-IN). Method: Participants were 131 Spanish children (ages 6-16; 72% boys) diagnosed with ADHD. Results: In regression analyses, ADHD-IN was positively associated with hyperactivity/impulsivity, conduct problems, defiance/aggression, anxiety, peer relations problems, and learning problems. SCT-inconsistent alertness was positively associated with hyperactivity/impulsivity and peer relations problems. In contrast, SCT-slowness was negatively associated with hyperactivity/impulsivity and conduct problems and positively associated with depression and learning problems. Results were consistent after controlling for depression, medication status, and sex. Conclusion: The findings support SCT to be a construct with two dimensions that have unique correlates relative to each other as well as ADHD-IN. Future research on SCT should separate these dimensions of SCT to provide a better understanding of the construct.
Objective: To investigate clinical and functional outcomes in military men with ADHD. Method: Clinical outcomes were measured via the Zung Self-Rating Depression Scale (Zung SDS) and the Zung Self-Rating Anxiety Scale (Zung SAS). Functional outcomes were measured using the "Car, Relax, Alone, Forget, Friends, Trouble" (CRAFFT) questionnaire and questionnaires about relationships, conduct problems, substance use, and sleep. Results: Men with ADHD (n = 52) reported more depressive (34 [67.3%] vs. 19 [38%], p = .008) and anxiety symptoms (31 [61.5%] vs. 14 [28%], p = .009) compared with those without (n = 50). They had relationships lasting less than 1 year (24 [80%] vs. 9 [37.5%], p = .006), were more likely to smoke (17 [32.7%] vs. 5 [10%], p = .005), were most likely to use illicit substances (6 [11.5%] vs. 0 [0%], p < .001), had more conduct problems at school (27 [51.9%] vs. 5 [10%], p < .001), and had longer sleep latency (53.96 min ± 46.48 vs. 25.78 min ± 25.93, p = .006). Conclusion: Military men with ADHD are significantly associated with worse clinical and functional outcomes. They should be screened and monitored for depression, anxiety, sleep disorders, and substance use.
Objective: This article describes results from a randomized clinical trial of a mindfulness-based intervention for parents and children, Mindful Family Stress Reduction, on a behavioral measure of attention in youths, the Attention Network Task (ANT). Method: Forty-one parent–child dyads were randomly assigned to either the mindfulness-based intervention condition or a wait-list control. School-age youths completed the ANT before and after the intervention. Results: Results demonstrate significant, medium-size (f 2 = –.16) intervention effects to the conflict monitoring subsystem of the ANT such that those in the intervention condition decreased in conflict monitoring more than those in the wait-list control. Youths in the intervention condition also showed improvements in their orienting subsystem scores, compared with controls. Conclusion: Mindfulness-based interventions for youths have potential utility to improve attentional self-regulation, and future research should consider incorporating measures of attention into interventions that use mindfulness training.
Objective: Longitudinal follow-up of ADHD suggests a poorer outcome in those affected. Studies extending to 30 years however are rare. We investigated the adult outcome of ADHD associated with perinatal risks (PRs), treated non-pharmacologically. Method: A study group of 122 participants (86 men, 36 women) with PR-associated ADHD was followed-up from birth and compared with a control group also prospectively studied. Results: The study group showed more cognitive, motor perception, and learning impairments as well as psychiatric problems at ages 5, 9, and 16. At age 30, the study group reported less education, more involuntary job dismissals and more alcohol abuse. Self-reported ADHD symptoms were still prevalent in adulthood. Conclusion: ADHD symptoms persist and impair the long-term educational, occupational, and psychiatric outcome. ADHD in participants with PR appears to follow a course seen in studies of unselected ADHD.
Objective: To explore the utility of cognitive measures for predicting response of children and adolescents to methylphenidate (MPH). Method: Participants from the International Study to Predict Optimized Treatment–in ADHD (iSPOT-A) completed a cognitive test battery prior to receiving 6 weeks of MPH. The responder criterion was a 25% reduction in ADHD-Rating Scale-IV scores. Receiver Operator Characteristics (ROC) classified non-responders from responders with maximal sensitivity and specificity. Results: Overall, 62% of participants responded to MPH. Response rates for ROC-identified groups ranged from 18% to 85%. Non-responders showed compromised cognition related to switching of attention, sustained attention, planning, and impulsivity. One group of responders were 10 years of age or older and had impaired switching of attention and impulsivity; a second group had enhanced switching of attention, normal or higher Continuous Performance Task (CPT) scores, and above average scores on digit span. Conclusion: Cognitive tests may provide a simple, low-cost tool for treatment planning for children and adolescents with ADHD.
Objective: Tourette syndrome (TS) can be associated with cognitive dysfunction. We assessed a range of cognitive abilities in adults with TS without comorbid disorders. Method: Participants completed tests of sustained attention, verbal and non-verbal reasoning, comprehension, verbal fluency, working memory, inhibition, and set-shifting. We compared patients’ task performance with that of healthy controls, and evaluated relationships between cognitive abilities and symptoms of obsessive-compulsive disorder (OCD), ADHD, impulse control problems, and mood disorders. Results: Patients with TS exhibited impairments on four measures assessing response inhibition, fine motor control, set-shifting, and sustained attention. The Wisconsin Card Sorting Test (WCST) discriminated best between patients and controls. Patients’ deficits were not correlated with tic severity or symptoms related to OCD, ADHD, or mood disorders. Conclusion: Deficits on the WCST could constitute a neurocognitive endophenotype for TS, reflecting dysfunction within neural networks involving basal ganglia, pre-supplementary motor area, and inferior prefrontal regions.
Objective: To evaluate the performance of adults with ADHD considering the fractionation of executive functions into six different domains. Method: Participants were adult ADHD patients who were not under the acute effects of medication (n = 48). Their performance was compared with that of a healthy control group (n = 20) of comparable age, education, and nonverbal intelligence quotient. The cognitive domains assessed were executive shifting, updating, inhibition of prepotent responses, dual-task performance, planning, and access to long-term memory. We also assessed the symptoms of inattention, hyperactivity/impulsivity, anxiety, and depression by validated questionnaires. Results: Compared with controls, patients reported more symptoms related to ADHD, anxiety and depression symptoms and were impaired in the shifting cost measure and phonemic fluency (measure of access to long-term memory). Conclusion: ADHD in adults selectively impaired executive shifting and access to long-term memory, domains that may alter performance in a wide range of daily tasks.
Objective: This study aimed to characterize clusters of children based on ADHD and sensory over-responsivity (SOR) symptoms, and to compare their markers. Method: Parents of 922 infants completed the Infant–Toddler Social and Emotional Assessment (ITSEA) Sensory Sensitivity, Attention, and Activity/Impulsivity scales at three time points during early childhood and the Child Behavior Checklist (CBCL) and SensOR inventory during elementary school age. Results: Four school-age clusters emerged from the CBCL ADHD and SensOR scores: (a) elevated SOR symptoms only (n = 35); (b) elevated ADHD symptoms only (n = 38); (c) elevated ADHD and SOR symptoms (ADHD + S, n = 35); and (d) low ADHD and SOR symptoms (n = 814). The SOR and ADHD + S clusters had higher early Sensitivity scores than the ADHD and Low clusters. The ADHD and ADHD + S clusters differed from the SOR and Low clusters in their early Attention and Activity/Impulsivity scores. Conclusion: SOR and ADHD symptoms occur independently and consistently over time.
Objective: This study explored auditory and visual attention in children with ADHD. Method: In a randomized, two-period crossover design, 50 children with ADHD and 50 age- and sex-matched typically developing peers were measured with the Test of Various Attention (TOVA). Results: The deficiency of visual attention is more serious than that of auditory attention in children with ADHD. On the auditory modality, only the deficit of attentional inconsistency is sufficient to explain most cases of ADHD; however, most of the children with ADHD suffered from deficits of sustained attention, response inhibition, and attentional inconsistency on the visual modality. Our results also showed that the deficit of attentional inconsistency is the most important indicator in diagnosing and intervening in ADHD when both auditory and visual modalities are considered. Conclusion: The findings provide strong evidence that the deficits of auditory attention are different from those of visual attention in children with ADHD.
Objective: To compare the clinical presentation of ADHD between youth with autism spectrum disorder (ASD) and ADHD and a sample of youth with ADHD only. Method: A psychiatrically referred sample of autism spectrum disorder (ASD) youth with ADHD attending a specialized ambulatory program for ASD (n = 107) and a sample of youth with ADHD attending a general child psychiatry ambulatory clinic (n = 74) were compared. Results: Seventy-six percent of youth with ASD met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. The clinical presentation of ADHD in youth with ASD was predominantly similar to its typical presentation including age at onset (3.5 ± 1.7 vs. 4.0 ± 1.9; p = .12), distribution of diagnostic subtypes, the qualitative and quantitative symptom profile, and symptom severity. Combined subtype was the most frequent presentation of ADHD in ASD youth. Conclusion: Despite the robust presentation of ADHD, a significant majority of ASD youth with ADHD failed to receive appropriate ADHD treatment (41% vs. 24%; p = .02). A high rate of comorbidity with ADHD was observed in psychiatrically referred youth with ASD, with a clinical presentation typical of the disorder.
Objective: Although earlier work has shown a link between mind-wandering and ADHD symptoms, this relationship has not been further investigated by taking into account recent advances in mind-wandering research. Method: The present study provides a comprehensive assessment of the relationship between mind-wandering and ADHD symptomatology in an adult community sample (N = 105, 71 females, M age = 23.1) using laboratory measures and experience sampling during daily life. Results: Mind-wandering and detrimental mind-wandering were positively associated with ADHD symptoms. Meta-awareness of mind-wandering mediated the relationship between ADHD symptomatology and detrimental mind-wandering, suggesting that some of the negative consequences can be ameliorated by strategies that facilitate meta-awareness. Interestingly, participants with low ADHD scores showed a positive relationship between detrimental mind-wandering and useful mind-wandering; however, participants with high ADHD scores failed to engage in this type of "strategic" mind-wandering. Conclusion: These results provide new insights into the relationship between ADHD symptomatology and mind-wandering that could have important clinical implications.
Objective: To determine the prevalence of ADHD among primary school pupils in a rural community in Southeastern Nigeria and to determine the psychosocial factors associated with the condition. Method: One hundred eighty-one randomly selected participants had their teachers complete the school version of ADHD Rating Scale–IV. Their parents also completed a sociodemographic questionnaire, the clinical interview form for the child and adolescent ADHD patients, and home version of the ADHD Rating Scale–IV. Results: Twelve (6.6%) of the children met the criteria for diagnosis. A history of prolonged labor (odds ratio [OR] = 14.1; 95% confidence interval [CI] = [2.13, 93.1]), and parents’ negative assessment of their marriages (OR = 0.1; CI = [0.017, 0.567]) were the most predominant factors which independently associated with the ADHD in the children. Conclusion: There is, therefore, a need for the care of rural dwelling African children, who otherwise would have difficulties accessing health care that is concentrated in the cities.
Objective: To investigate the interaction between childhood trauma exposure with the catechol-O-methyltransferase (COMT) and dopamine receptor D4 (DRD4) polymorphisms in relation to neuropsychological measures in children with ADHD. Method: A cross-sectional examination of early traumatic experiences and the continuous performance test (CPT) were performed in 55 children with ADHD. Participants were also genotyped for the DRD4 exon III 48-bp variable number of tandem repeats (VNTR) polymorphism and the COMT Val158-Met (rs4680) polymorphism. Results: There was significant interaction between the effects of the COMT genotype and trauma in commission errors. In participants with ADHD carrying the COMT Val/Val genotype, the group exposed to trauma showed significantly higher commission errors than the non-traumatized group. However, for the participants with other genotypes, no significant differences were found. Conclusion: This study suggests that there exists a genetic influence on the association between childhood trauma and the severity of inhibitory deficits in children with ADHD.
Objective: Studies on ADHD in educational settings indicate that a student’s motivation for learning is significantly related with the student’s grade point average. The present study examined the relationship between ADHD symptoms and student academic achievement by considering the student’s approach to and motivation for learning. Method: Participants completed a questionnaire that breaks down learning strategies into a surface or deep approach. Each approach is then divided into a deep or surface motivation and strategy. Results: A multivariate analysis of variance determined that those in the control group were using the deep approach, whereas those in the ADHD group strongly favored the surface approach. Furthermore, ADHD participants preferred surface motive and surface strategy. A factor analysis of a study-habits questionnaire identified five categories, with collaborative learning approaching significant levels. Conclusion: Implications for guiding ADHD college students toward effective study strategies are discussed in light of their preference for surface approach, motive, and strategy.
Objective: To explore the impact of early-onset bipolar disorder (pediatric bipolar disorder [PBD]) on ADHD. Method: We compared ADHD symptom severity, ADHD subtype distribution, and rates of comorbid and familial psychiatric disorders between 49 ADHD children with comorbid PBD and 320 ADHD children without PBD. Results: Children with ADHD and PBD showed higher scores in the Hyperactive and Inattentive subscales of the ADHD Rating Scale, than children with ADHD alone. The frequency of combined subtype was significantly higher in ADHD children with PBD, than in those with ADHD alone. ADHD children with PBD showed a higher rate of familial psychiatric disorders than ADHD children without PBD. The rate of conduct disorder was significantly greater in children with PBD and ADHD compared with children with ADHD alone. Conclusion: ADHD along with PBD presents with several characteristics that distinguish it from ADHD alone, suggesting that these may be distinct disorders.
Objective: Little systematic information is available regarding how sleep problems influence daytime functioning in children with ADHD, as the role of ADHD presentations and comorbidity is unclear. Method: In total, 397 children were assessed with the Children’s Sleep Habits Questionnaire, the Weiss Functional Impairment Rating Scale, and the ADHD Rating Scale. Results: We found a moderate, positive correlation between sleep problems and impaired functioning in both children with ADHD and in typically developed children. ADHD presentations did not differ significantly with respect to sleep problem profile, but having a comorbid internalizing or autistic disorder lead to higher sleep problem score. Conclusion: Sleep problems and impaired daily functioning were more common in children with ADHD, but the overall association between sleep problems and impaired daily functioning was similar in clinical and nonclinical children. Internalizing or autistic comorbid disorders added significantly to the sleep problems.
Objective: Our aim was to evaluate the Quality of Life (QoL) of treatment naïve children with ADHD. Method: Data from 178 parent–child dyads were analyzed using multiple regression to assess the relationships between QoL, and characteristics of ADHD and comorbid psychopathology. Results: Lower self-reported QoL was associated with female gender, higher age, more symptoms of anxiety and trauma-related disorders in dimensional approach, and with the comorbid diagnoses of trauma-related disorders and oppositional defiant disorder (ODD)/conduct disorder (CD) in categorical approach. Lower parent-reported QoL was related to older age and increasing number of symptoms of mood and anxiety disorders on one hand, and any diagnosis of mood and anxiety disorders and ODD/CD on the other. Conclusion: Our results draw the attention to the importance of taking into account age, gender, and both self- and parent reports when measuring QoL of children with ADHD and both dimensional and categorical approaches should be used.
Objective: Studies demonstrate sluggish cognitive tempo (SCT) symptoms to be distinct from inattentive and hyperactive-impulsive dimensions of ADHD. No study has examined SCT within a bi-factor model of ADHD, whereby SCT may form a specific factor distinct from inattention and hyperactivity/impulsivity while still fitting within a general ADHD factor, which was the purpose of the current study. Method: A total of 168 children were recruited from an ADHD clinic. Most (92%) met diagnostic criteria for ADHD. Parents and teachers completed measures of ADHD and SCT. Results: Although SCT symptoms were strongly associated with inattention, they loaded onto a factor independent of ADHD g. Results were consistent across parent and teacher ratings. Conclusion: SCT is structurally distinct from inattention as well as from the general ADHD latent symptom structure. Findings support a growing body of research suggesting SCT to be distinct and separate from ADHD.
Objective: The current study introduces the Parental Emotional Response to Children Index (PERCI), a new questionnaire specifically designed to measure parents’ emotional response to ADHD and related behaviors (delay discounting and delay aversion). Method: The PERCI was completed by parents of 6- to 14-year-old children with (n = 126) and without (n = 160) ADHD. Results: Factor analysis confirmed five separate subscales with acceptable psychometric properties. Parents of children with ADHD reported a stronger emotional response to ADHD behaviors than parents of typically developing children and inattention symptoms evoked the strongest emotional response in parents regardless of child diagnostic status. Conclusion: Parents’ emotional responses appear to be differentiated in terms of specific ADHD-related triggers mapping onto the different domains of ADHD and delay-related responses. Further research is required to understand changes in parental emotional responses over time and their impact on children’s developmental trajectories.
Objective:To investigate the prevalence of ADHD medication prescribing of school-aged children in Hong Kong (HK) from 2001 to 2013 and to compare with other countries. Method: Using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System, we investigated the epidemiology and prevalence of ADHD medication prescribing. Results: The prevalence of children on ADHD medication increased 14 times throughout the study period—0.072% in 2001 (95% confidence interval [CI] = [0.068%, 0.077%]) to 1.027% (95% CI = [1.008%, 1.047%]) in 2013. Prevalence in females increased at a faster rate than in males. The prescribing trend in kindergarten children (3- to 5-year-old) was relatively steady from 2001 to 2008—0.025% (95% CI = [0.019%, 0.033%]) in 2001—until a marked increase from 2009 to 2013—0.121% (95% CI = [0.105%, 0.139%]) in 2013. Conclusion: The prevalence of ADHD medication prescribing in Hong Kong is increasing but remains lower than most Western countries. However, the prevalence of ADHD medication prescribing for kindergarten children should be monitored to ensure appropriate use.
Objective: Patterns of co-occurrence between ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) were examined in a sample of non-referred preschool children. ADHD subtypes and sex differences were also explored. Method: Children aged 3.5 years (n = 1,048) with high scores on ADHD characteristics were recruited from the Norwegian Mother and Child Cohort Study and clinically assessed, including a semi-structured psychiatric interview. Results: In children with ADHD, concurrent ODD was present more often than CD (31% vs. 10%), but having ADHD gave higher increase in the odds of CD than of ODD (ODD: odds ratio [OR] = 6.7, 95% confidence interval [CI] = [4.2, 10.8]; CD: OR = 17.6, 95% CI = [5.9, 52.9]). We found a greater proportion of children having the combined ADHD subtype as well as more severe inattentiveness among children with co-occurring CD compared with ODD. Sex differences were minor. Conclusion: There are important differences in co-occurring patterns of ODD and CD in preschool children with ADHD.
Objective: In our study, we aimed to evaluate the plasma homocysteine levels and oxidative stress parameters in patients with adult ADHD (A-ADHD). Method: Blood samples were taken from 32 A-ADHD patients and 32 controls enrolled in the study and plasma homocysteine, serum folate, vitamin B12, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined. Results were compared between the groups. Results: Patients’ plasma homocysteine level was significantly lower and serum folate level was significantly higher than the controls. The means of plasma homocysteine and folate levels were statistically significantly different between the groups (p < .05). However, a statistically significant difference was not detected between groups for mean serum vitamin B12, TAS, TOS, and OSI levels (p > .05). Conclusion: Our study suggests that oxidative balance is not impaired in A-ADHD, and contrary to other psychiatric disorders, homocysteine levels were found to be lower.
Objective: This study compared the romantic relationships of adolescents with and without ADHD with regard to romantic involvement, relationship content, and relationship quality. Method: A community sample of 58 participants (30 ADHD, 28 Comparison), ages 13 to 18, completed questionnaires assessing various features of romantic relationships. Results: Adolescents with ADHD reported having more romantic partners than their typically developing (TD) peers. Females with ADHD were found to have shorter romantic relationships than TD adolescents while males with ADHD reported their age of first intercourse to be nearly 2 years sooner than TD peers. Irrespective of gender, adolescents with ADHD had nearly double the number of lifetime sexual partners. However, the romantic relationships of adolescents with and without ADHD did not differ on levels of aggression or relationship quality. Conclusion: Given the outcomes associated with poor-quality romantic relationships, comprehensive assessments of adolescents with ADHD should include queries into their romantic relationships.
Objective: This study assesses planning skills of adolescents with ADHD using a multi-method assessment and explores subtype differences between inattentive and combined subtypes. Method: One hundred fifteen adolescents with ADHD and 34 typically developing controls completed subtests of the Delis–Kaplan Executive Function System (D-KEFS), Behavioral Assessment of the Dysexecutive Syndrome (BADS), and Behavior Rating Inventory of Executive Function (BRIEF). Results: No group differences were found on the D-KEFS. The BADS Zoo Map test showed longer completion times in the inattentive than in the combined subtype and controls. The BRIEF showed more planning problems in adolescents with ADHD (both subtypes) than in controls, with the combined subtype showing most problems on overall executive functioning. Conclusion: Only a proportion of adolescents with ADHD shows planning deficits. To capture these planning problems in adolescents with ADHD, it seems important to use multiple measures of planning, both ratings and "less structured" neurocognitive measures of planning.
Objective: To evaluate the efficacy and safety of memantine hydrochloride as an adjunct to stimulant pharmacotherapy for treating executive function deficits (EFDs) in adults with ADHD. Method: This was a 12-week, double-blind, placebo-controlled, randomized clinical trial of memantine added to open-label treatment with stimulant medication. Because of the small sample size, we considered a standardized mean difference (equivalent to effect size) of ≥0.5 and odds ratios ≥2 as indicators of trend improvements. Results: Twelve participants received memantine and 14 received a placebo. Trend improvements favoring memantine were observed on Behavior Rating Inventory of Executive Functions–Adult Inhibition and Self-Monitor subscales when compared with Placebo. No significant changes were noted on the Cambridge Neuropsychological Test Automated Battery. Conclusion: Among adults with ADHD and EFDs, adjunct treatment with memantine to osmotic release oral system-methylphenidate (OROS-MPH) was associated with improvements in selective areas of executive functioning, supporting the need for further research.
Objective: The nature of ADHD, especially in adulthood, is not well-understood. Therefore, we explored subcomponents of attention in adult ADHD. Method: Twenty-three adults with ADHD were tested on neurocognitive and visual tracking performance both while on their regular prescription stimulant medication and while abstaining from the medication for 1 day. Pairwise comparisons to 46 two-for-one matched normal controls were made to detect medication-resistant effects of ADHD, and within-participant comparisons were made to detect medication-sensitive effects in patients. Results: Even when on medication, patients performed more poorly than controls on a spatial working memory task, and on visual tracking and simple reaction time tasks immediately following other attention-demanding tasks. Patients’ visual tracking performance degraded while off-medication in a manner consistent with reduced vigilance. Conclusion: There may be persistent cognitive impairments in adult ADHD despite medication. In addition, the benefit of stimulants seems reduced under cognitive fatigue.
Objective: The purpose of the study was to evaluate an Internet-based cognitive behavioral therapy (iCBT) program targeting difficulties and impairments associated with adult ADHD. Method: Forty-five adults diagnosed with ADHD were randomized to either self-help (iCBT self-help format [iCBT-S]), self-help with weekly group sessions (iCBT group-therapy format [iCBT-G]), or a waiting-list control group. Treatment efficacy was measured at pre- and posttreatment and at 6-month follow-up. Results: Intention-to-treat (ITT) analysis showed a significant reduction in ADHD symptoms for the iCBT-S group in comparison with the waiting-list controls at posttreatment, with a between-group effect size of d = 1.07. The result was maintained at 6-month follow-up. No significant difference was found at posttreatment or 6-month follow-up between the iCBT-S and iCBT-G groups. Conclusion: The findings show that a CBT treatment program administered through the Internet can be a promising treatment for adult ADHD. Limitations of the study design and directions for future research are discussed.
Objective: To screen for ADHD in a sample of Egyptian adolescent students, and study the distribution of different subtypes of ADHD, associated comorbidities, and sociodemographic correlates. Method: A total of 925 adolescents were randomly selected and screened by the Conners-Wells’ Adolescent Self-Report Scale–Short form (CASS:S), and potential cases were further assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime versions (K-SADS-PL). Results: A total of 87 students (9.4%) had potential ADHD diagnosis with evident preponderance in boys (13.8%, n = 58) than in girls (5.8%, n = 29) with a ratio of 2:1 (p = .000, 2 = 17.328). The hyperactive-impulsive subtype comprised the majority of cases (54.7%, n = 41). Psychiatric comorbidity was invariably present (85.1%, n = 74). Nearly half the cases had poor academic achievement (43.7%, n = 34). Positive correlates included family history of psychiatric disorders, the order of birth, and parental disharmony. Conclusion: ADHD is prevalent in Egyptian adolescents and is associated with high psychiatric comorbidity and a pronounced effect on academic performance.
Objective: To test whether an optimal dose of Quillivant XR (methylphenidate extended-release oral suspension [MEROS]) would significantly reduce symptoms of ADHD in children. Method: A randomized, double-blind, placebo-controlled, cross-over, efficacy, safety, and tolerability study of MEROS in 45 children aged 6 to 12 years (open-label dose-optimization phase, followed by double-blind cross-over period). Results: MEROS was significantly more efficacious than placebo during double-blind cross-over laboratory classroom days (Swanson, Kotkin, Agler, M-Flynn, and Pelham Rating Scale and Permanent Product Measure of Performance). During the open-label phase, improvements were observed in scores of ADHD Rating Scale-IV, and Clinical Global Impression-Severity and -Improvement Scales. No occurrences of suicidal ideation or behavior were recorded; the most common open-label treatment-emergent adverse events were typical of stimulant use: decreased appetite, insomnia, and abdominal pain. Conclusion: MEROS was efficacious in the treatment of children aged 6 to 12 years with ADHD, with a safety profile similar to that of other extended-release methylphenidate pharmacotherapies.
Objective: This exploratory study investigated how the timing of female pubertal maturation was associated with the symptoms of ADHD in a non-clinical female undergraduate sample (N = 253). Method: Participants (M age = 20.2 ± 1.7 years) completed a set of self-report rating scales examining pubertal onset and ADHD symptoms and related deficits. Results: Logistic regression analysis indicated that early puberty was associated with elevation in symptoms, including difficulties in attention (odds ratio [OR] = 1.270, p = .019), emotion regulation (OR = 1.070, p = .038), and more risky behavior (OR = 1.035, p = .045). That is, increased symptom endorsement was shown to significantly help classify those who reported having an earlier pubertal onset relative to their peers. Conclusion: Findings highlight the potential role of sex hormones during puberty in explaining the gender differences in prevalence rates of ADHD and symptom profiles.
Objective: ADHD affects between 2% and 8% of college students and is associated with broad functional impairment. No prior randomized controlled trials with this population have been published. The present study is a pilot randomized controlled trial evaluating dialectical behavior therapy (DBT) group skills training adapted for college students with ADHD. Method: Thirty-three undergraduates with ADHD between ages 18 and 24 were randomized to receive either DBT group skills training or skills handouts during an 8-week intervention phase. ADHD symptoms, executive functioning (EF), and related outcomes were assessed at baseline, post-treatment, and 3-month follow-up. Results: Participants receiving DBT group skills training showed greater treatment response rates (59-65% vs. 19-25%) and clinical recovery rates (53-59% vs. 6-13%) on ADHD symptoms and EF, and greater improvements in quality of life. Conclusion: DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation.
Objective: Post-error slowing (PES) is a cognitive mechanism for adaptive responses to reduce the probability of error in subsequent trials after error. To date, no meta-analytic summary of individual studies has been conducted to assess whether ADHD patients differ from controls in PES. Method: We identified 15 relevant publications, reporting 26 pairs of comparisons (ADHD, n = 1,053; healthy control, n = 614). Random-effect meta-analysis was used to determine the statistical effect size (ES) for PES. Results: PES was diminished in the ADHD group as compared with controls, with an ES in the medium range (Cohen’s d = 0.42). Significant group difference was observed in relation to the inter-stimulus interval (ISI): While healthy participants slowed down after an error during long (3,500 ms) compared with short ISIs (1,500 ms), ADHD participants sustained or even increased their speed. Conclusion: The pronounced group difference suggests that PES may be considered as a behavioral indicator for differentiating ADHD patients from healthy participants.
Objective: This study explored how a 12-week simulated developmental horse-riding program (SDHRP) combined with fitness training influenced the motor proficiency and physical fitness of children with ADHD. Method: Twelve children with ADHD received the intervention, whereas 12 children with ADHD and 24 typically developing (TD) children did not. The fitness levels and motor skills of the participants were assessed using standardized tests before and after the 12-week training program. Results: Significant improvements were observed in the motor proficiency, cardiovascular fitness, and flexibility of the ADHD training group following the intervention. Conclusion: Children with ADHD exhibit low levels of motor proficiency and cardiovascular fitness; thus, using the combined 12-week SDHRP and fitness training positively affected children with ADHD.
Objective: Autism Spectrum Disorders (ASD) and ADHD are assumed to be the extreme manifestations of continuous heterogeneous traits that frequently co-occur. This study aims to identify subgroups of children with distinct ASD–ADHD trait profiles in the general population, using measures sensitive across both trait continua, and show how these subgroups differ in cognitive functioning. Method: We examined 378 children (6-13 years) from a population-based sample. Results: Latent class analyses (LCA) detected three concordant classes with low (10.1%), medium (54.2%), or high (13.2%) scores on both traits, and two discordant classes with more ADHD than ASD characteristics (ADHD > ASD, 18.3%) and vice versa (ASD > ADHD, 4.2%). Findings suggest that ASD and ADHD traits usually are strongly related in the unaffected population, and that a minority of children displays atypical discordant trait profiles characterized by differential visual-spatial functioning. Conclusion: This dissociation suggests that heterogeneity in ASD and ADHD is rooted in heterogeneity in the lower unaffected end of the distribution.
Objective: The aim of this study was to determine the frequency of childhood ADHD comorbidity in patients with social anxiety disorder (SAD), and the influence of this comorbidity on various demographic and clinical variables in SAD. Method: A total of 130 patients with SAD were assessed with K-SADS-PL’s (Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version) behavioral disorders module to determine the childhood diagnosis of ADHD. Patients with or without a comorbid childhood ADHD were compared in terms of clinical characteristics and rating scores. Results: The mean age at onset of SAD was lower, and lifetime major depressive disorder and bipolar disorder (BD) comorbidity were higher in the SAD–ADHD group than in the SAD–without ADHD group. Conclusion: We have found high ADHD comorbidity in patients with SAD. Presence of comorbid ADHD was associated with increased severity, functional impairment, and BD comorbidity.
Objective: To examine the associations between ADHD and social functioning and participation among older adults. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In 2008/2009, respondents were asked about social functioning and participation. A diagnostic interview to diagnose ADHD was administered among a subsample (N = 231, age 60-94 years). ADHD diagnosis and level of ADHD symptoms were assessed. Results: ADHD diagnosis was associated with being divorced/never married, having less family members in their network, and emotional loneliness. Level of ADHD symptoms was associated with more emotional support given, emotional and social loneliness, greater recreational social participation, and lower income level. Conclusion: This study shows that ADHD in old age is related to being divorced/never married and loneliness but not to work participation. Psycho geriatric practices should direct their attention to loneliness when treating ADHD.
Objective: Despite widespread use, there is little data investigating the long-term impact of micronutrients on psychiatric disorders. This study investigated the naturalistic outcome 1-year post-baseline of a randomized controlled trials (RCT) that compared micronutrients with placebo in 80 adults with ADHD. Method: All participants were contacted and clinician-rated questionnaires completed. Results: A total of 72 (90%) of the sample participated; although there was significant regression in psychiatric functioning from the end-of-trial on all measures, outcomes remained significantly improved from baseline. Dominant treatment from the end-of-treatment to follow-up was investigated as a mediator of outcome; those staying on the micronutrients performed better than those who switched to medications or discontinued micronutrients. Cost was the most substantial reason why people stopped micronutrient treatment. Conclusion: For the small number of participants who stayed on micronutrients, the benefits conferred through the controlled trial were maintained. The results are limited by small sample, lack of blinding, expectation, and reliance on self-report of symptoms.
Objective: Individuals with ADHD may be at risk of developing binge eating disorder (BED). Impulsivity correlates with both BED and ADHD; however, more research is needed to explore whether impulsivity plays an underlying role in the observed relationship between ADHD and BED. Method: Questionnaires were used to assess ADHD and BED symptoms. Multiple questionnaires and a behavioral task were used to assess impulsivity in undiagnosed undergraduate participants (n = 50). Results: Expected correlations were found among ADHD symptoms, BED tendencies, and measures of impulsivity with the exception of impulsivity on the behavioral task and BED symptoms; however, none of the measures of impulsivity were found to be significant mediators between ADHD and BED symptoms. Conclusion: Although impulsivity may play an important role in the interrelationship of ADHD and binge eating, other factors may also be critical in the development of this comorbidity. Investigation of this research question in clinical samples is needed.
Objective: Children with ADHD lack self-awareness of their social and academic deficits, frequently rating themselves more favorably than external sources. The purpose of the current study was to assess whether adolescents with ADHD also hold a positive bias toward their executive functioning (EF). Method: Participants include 22 control and 35 ADHD subjects, aged 11 to 16. Participants and their parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) Self and Parent forms, respectively. Discrepancy scores were calculated for each domain by subtracting the adolescents’ T-score from the parents’ T-score. Results: Discrepancy scores were significantly higher in the ADHD group than controls within the Inhibit, Shift, Monitor, Emotional Control, Working Memory, and Plan/Organization domains (all p < .05). Conclusion: As compared with controls, adolescents with ADHD tend to endorse fewer EF difficulties than what parents report. This is the first study to demonstrate that those with ADHD may overestimate their EF ability.
Objective: To examine dispensing patterns of methylphenidate (MPH) to determine how socioeconomic status (SES), ethnocultural affiliation, and gender affect the medical treatment of ADHD. Method: We reviewed MPH prescription records for year 2011 of children aged 6 to 18, from regional pharmacies serving homogeneous neighborhoods. Results: MPH prescriptions showed an increase in prevalence from 4.2% to 7.5% in the years 2007 to 2011, respectively. Jewish children were four times more likely to be prescribed MPH than Arab children, with significant discrepancies along SES and gender lines (p < .001). Higher SES and male gender were associated with greater use of MPH. General pediatric prescription rates of MPH in all communities increased by 85%, compared with year 2007 statistics (p < .001). Conclusion: Prescription patterns for MPH in children reflect diagnostic patterns of ADHD that appear to be heavily influenced by additive factors of SES, cultural attitudes, and gender. Dispensing data provide valuable information for targeting underserved groups and defining potential areas of abuse.
Objective: To assess whether the relationship of an ADHD diagnosis by adolescence to nonprescription stimulant use in adulthood is direct or indirect, via Conduct Disorder (CD) and/or Substance Use Disorder (SUD). Method: Data were obtained from multiple waves of interviews and questionnaires completed by 551 community-based participants when they were between the mean ages of 14.1 and 36.6 years. Results: The results of the structural equation model (SEM) supported both a direct association between early ADHD and later nonprescription stimulant use (B = .18, z = 2.74) and the relationship from ADHD to later nonprescription stimulant use (B = .01, z = 1.72) via CD and SUD. Conclusion: The longitudinal data supporting these paths suggest that efforts to prevent and treat the misuse of nonprescription stimulants may be more effective if attention is paid to those with a history of ADHD, as well as to those who also had CD and SUD.
Objective: This is a randomized control trial examining the efficiency of computerized cognitive training (CCT) for adults with ADHD, comparing two training conditions with graded levels of executive cognitive demands. Method: Adults with ADHD (n = 60) were randomized into study (n = 34) and control (n = 26) groups. Training was conducted with the computerized AttenFocus program. Control group received a simple, non-hierarchical version with less executive demands. Results: Significant positive changes in symptoms ratings, ecological measures of executive functions, and occupational performance were found in both groups. No significant changes were found in variables of neurocognitive performance battery and quality of life. No significant time by group interaction effects were found. Conclusion: No benefits of the intervention were found relative to the control. Lack of interaction effects may be due to insufficient power, non-specific cognitive training or placebo effects. Results demonstrate some positive findings for general CCT, yet do not support the inclusion of specific higher level executive training.
Objective: The objective of this study was to examine graduate students’ non-medical use of prescription stimulant medication, and the relationship between non-medical use of prescription stimulants with academic self-efficacy, psychological factors (i.e., anxiety, depression, and stress), and internal restlessness. Method: The sample consisted of 807 graduate students from universities located in five geographic regions of the United States. Results: Past-year rates of self-reported non-medical use were determined to be 5.9%, with overall lifetime prevalence of 17.5%. Observed self-reported non-medical use of prescription stimulant medications was significantly correlated with self-reported levels of anxiety and stress, various aspects of internal restlessness, and perceived safety of the medications. Conclusion: Findings support graduate students’ motivations of non-medical prescription stimulant use to be both academic and social in nature. Effective prevention and education efforts are needed to help address the non-medical use of prescription stimulants by graduate students on university campuses.
Objective: The primary aim of this study was to evaluate whether school maladjustment longitudinally predicts the daytime sleepiness of college students with ADHD above and beyond symptoms of ADHD and to determine whether internalizing dimensions mediate the relationship between maladjustment and sleepiness. Method: A prospective longitudinal study of 59 college students comprehensively diagnosed with ADHD who completed ratings at the beginning, middle, and end of the school year. Results: School maladjustment at the beginning of the year significantly predicted daytime sleepiness at the end of the year above and beyond symptoms of ADHD. Locus of control mediated the relationship between maladjustment and daytime sleepiness. Conclusion: The significant school maladjustment difficulties that students with ADHD experience following the transition to college may lead to the development of problems with daytime sleepiness, particularly for those students with high external locus of control. This pattern is likely reciprocal, whereby sleep problems in turn result in greater school impairment, reinforcing the idea that life events are outside of one’s control.
Objective:It has been suggested that high levels of prenatal testosterone exposure are implied in the etiology of male preponderance disorders such as autism spectrum disorder and ADHD. Within this scope, we studied the sex ratio (proportion of males) in siblings of individuals diagnosed with ADHD in childhood and adolescence. Method: We did a nationwide, register-based cohort study of the sex ratio in siblings of the 16,381 patients in Denmark diagnosed with ADHD at age 17 years and younger and registered in the nationwide Danish Psychiatric Central Register between January 1, 1994 and May 28, 2013. Results: Among the 33,151 siblings, 17,041 were males and 16,110 females. This yields a sex ratio of 0.514, which is not statistically significant different from the Danish live birth sex ratio of 0.513 during the relevant years (p = .70). Conclusion: These findings provide no support for the hypothesis that the sex ratio is elevated among the siblings of people with ADHD.
Objective: To assess perceptions concerning ADHD among U.S. college healthcare providers. Method: A 37-question survey was conducted from October 4 to December 2, 2010. Participants were contacted via mail or telephone and compensated for participation. Results: Thirty-eight percent of the respondents (physicians, n = 59; nurses, n = 138; directors, n = 101) viewed ADHD as a "problem"/"very much a problem" at their institution. Referrals for evaluation came from students (84%), psychologists/counselors (68%), or the institution (68%). Although 48% of respondents felt "comfortable"/"very comfortable" in their ability to recognize ADHD, 92% referred students for evaluation. Most respondents (>90%) agreed medication use may be warranted; 52% of respondents who treat ADHD or consult with a specialist (from 95% of physicians to 31% of directors) prescribed pharmacotherapy. Conclusion: Although college healthcare providers recognize the importance of treating ADHD, their discomfort in diagnosing and treating ADHD represents a barrier to care for college students.
Objective: To examine the extent to which effortful control (EC) and sensation seeking (SS) tendencies explain the association between the severity of ADHD symptoms and risky behaviors. Method: Participants included 555 college students (66% females) who completed self-report measures assessing their ADHD symptoms, EC abilities, SS tendencies, and risky health (e.g., substance use) and driving/financial behaviors (e.g., misuse of credit cards). Results: Severity of college students’ ADHD symptoms, EC abilities, and SS tendencies were related to all risky behaviors. Multiple mediational analyses further indicated that students’ SS tendencies significantly mediated the association between ADHD symptoms and the risky health factor but not the risky driving/financial factor. EC, however, significantly mediated the association between ADHD symptoms and both the risky health and driving/financial factors. Conclusion: The current study provides initial data showing potentially different mechanisms that explain the link between college students’ severity of ADHD symptoms and risky behaviors.
Objective: To evaluate sleep latency (SL) during the multiple sleep latency test (MSLT) and subjective daytime sleepiness in adult ADHD and controls. Method: Subjective daytime sleepiness was assessed by Epworth Sleepiness Scale (ESS) in 27 unmedicated adults with ADHD and in 182 controls. Thirteen ADHD patients and 26 controls underwent MSLT after one night of polysomnography (PSG). Results: Mean MSLT-SL was 10.6 ± 4.8 min in ADHD and 12.2 ± 4.2 min in controls (n.s.). Mean ESS score was 9.3 ± 4.9 points in ADHD and 6.9 ± 3.4 points in controls (p < .005). MSLT-SL and ESS scores correlated inversely by trend (r = –.45, p < .1) but not with ADHD symptoms or ADHD subtype. Conclusion: Adults with ADHD do not differ from controls in mean MSLT-SL but experience increased subjective daytime sleepiness. Patients with subjective higher daytime tiredness fell asleep faster during MSLT.
Objective: To examine the rates of psychiatric comorbidities within a New Zealand sample of adults with ADHD compared with a community control group. Method: We merged six data sets to obtain a sample of 222 adults (158 ADHD, 64 controls). Comorbidities were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev. [DSM-IV-TR]) Axis-I disorders. Results: Both groups were equivalent in IQ, socioeconomic status, gender, education, income levels, and age. Lifetime rates of psychiatric disorders were significantly higher in the ADHD group (83%) versus the control group (52%) with higher rates of major depressive disorder (MDD; 65% vs. 36%), social phobia (31% vs. 11%), substance abuse (26% vs. 8%), and alcohol abuse (32% vs. 14%). Within the ADHD group, other than a group difference in specific phobias, there were no gender differences. Conclusion: The findings are consistent with international research; adults with ADHD in New Zealand have higher rates of psychiatric disorders than the general population.
Objective: The aim was to analyze the psychometric properties of two screening instruments, Wender-Utah Rating Scale (WURS) that evaluates childhood ADHD and Adult ADHD Self-Report Scales (ASRS) that assesses symptoms in adulthood, in alcohol-dependent patients. Method: A total of 355 outpatients were included. Conners’ adult ADHD diagnostic interview results were used as a gold standard in childhood and adulthood ADHD. Results: The WURS with a 41 cutoff had a sensitivity of 79.6% and a specificity of 60.3%. The ASRS with a 14 cutoff had a sensitivity of 86.7% and specificity of 66.1%. Analyzing both rating scales in combination, it was observed that patients with positive ASRS and WURS presented a sensitivity of 92.3%. Patients with positive ASRS, but negative WURS, presented a specificity of 73.6%. Conclusion: WURS and ASRS are useful tools in the diagnosis of adult ADHD in alcohol-dependent patients; with the use of both instruments, the psychometric properties are substantially improved.
Objective: The current study sought to develop a culturally appropriate measure of functional impairment related to ADHD for diverse families, as research suggests that functional impairment may be a more culturally universal construct than symptomatology. Method: Seventy-four low-acculturated Latino parents (49 mothers and 25 fathers) of school-aged children provided quantitative and qualitative responses about problem recognition after viewing a language-free video of a child displaying symptoms and behaviors consistent with ADHD. Results: Thirty-two items were developed for the ADHD-FX scale based on most common responses given from participants. The scale is available in Spanish and English and instructs parents to consider how much each item affects their child in his or her everyday life (from 0 = not at all to 3 = a lot). Conclusions: The scale can provide an overall impairment score, as well as subscale scores in the theoretically derived domains of academic, peer, and familial impairment.
Objective: Studies demonstrate an association between sluggish cognitive tempo (SCT) and social impairment, although no studies have tested possible mechanisms of this association. This study aimed to (a) examine SCT in relation to college students’ social functioning; (b) test if SCT is significantly associated with emotion dysregulation beyond depressive, anxious, and ADHD symptoms; and (c) test if emotion dysregulation mediates the association between SCT symptoms and social impairment. Method: College students (N = 158) completed measures of psychopathology symptoms, emotion dysregulation, and social functioning. Results: Participants with elevated SCT (12%) had higher ADHD, depressive, and anxious symptoms in addition to poorer emotion regulation and social adjustment than participants without elevated SCT. Above and beyond other psychopathologies, SCT was significantly associated with social impairment but not general interpersonal functioning. SCT was also associated with emotion dysregulation, even after accounting for the expectedly strong association between depression and emotion dysregulation. Further analyses supported emotion dysregulation as a mediator of the association between SCT and social impairment. Conclusion: These findings are important for theoretical models of SCT and underscore the need for additional, longitudinal research.
Objective: Given that the diagnosis of adulthood ADHD depends on the retrospective self-report of childhood ADHD symptoms, this study aimed to establish whether current mood affects the accuracy of retrospective self-ratings of childhood ADHD. Method: Barkley’s Adult ADHD Rating Scale (BAARS) was used to assess the retrospective self- and parent-reports of childhood ADHD symptoms of 160 adults with ADHD and 92 adults without ADHD. Self-rated current mood was also measured using the Hospital Anxiety and Depression Scale (HADS). Results: Higher BAARS self-ratings correlated with higher HADS self-ratings. Strongest correlations were evident between hyperactive/impulsive symptoms and anxiety symptoms. There was no relationship between current mood and accuracy of self-report. Conclusion: Current mood does not affect the accuracy of retrospective self-ratings of ADHD. Future research should aim to provide new measures of anxiety in ADHD to avoid the double counting of hyperactive/impulsive and anxiety symptoms.
Objective: To study pharmacotherapy in adults aged 50+ with ADHD. Method: A survey was administered to adults with ADHD (≥50 years old). Participants on medication for ADHD were compared with those not on medications. Results: Mean age of participants was 55.8 years, and mean age when diagnosed with ADHD was 50.3 years. Ninety-five participants (63.8%) reported current psychopharmacological treatment for ADHD, 36 (24.2%) had stopped psychopharmacological treatment, and 18 (12.0%) were psychopharmacological treatment naive for ADHD. Those currently being treated psychopharmacologically for ADHD reported significantly improved attention relative to the two nonmedicated groups (p < .01). Among examined sample characteristics (including current psychopharmacological treatment for ADHD), employment was associated with a better outcome (odds ratio = 3.3, p = .006). Conclusion: The majority of adults aged 50+ with ADHD reported regular pharmacotherapy for ADHD. Participants currently receiving psychopharmacological treatment for ADHD reported better attention than those not receiving pharmacotherapy. Employment was associated with more favorable outcomes.
Objective: The purpose of this study was to evaluate aspects of emotion dysregulation (ED) that characterize young adolescents with ADHD, examine the effects of subtype and comorbidity, and determine the extent to which ED is related to aggression and rule-breaking and social impairment. Method: We examined which aspects of ED are most relevant to ADHD in 180 young adolescents (75% boys), as well as whether ED differs across ADHD subtypes or comorbid oppositional defiant disorder (ODD) status. We also examined the association between ED and aggression, rule-breaking, and social impairment. Results: Young adolescent females and males with ADHD exhibited various manifestations of ED, including behavioral dyscontrol in the presence of strong emotions and inflexibility/slow return to emotional baseline. ED did not differ as a function of ADHD subtype or comorbid ODD. Three aspects of ED, namely, low threshold for emotional excitability/impatience, behavioral dyscontrol in the face of strong emotions, and inflexibility/slow return to baseline, predicted three of six measured indices of parent- and self-reported social impairment, above and beyond comorbid ODD. Conclusions: ED is associated with ADHD among young adolescents, does not differ based on ADHD subtype or ODD status, and is associated with social impairment.
Objective: The current study investigated the combined effect of ADHD, previously associated with executive function (EF) deficits, and of bilingualism, previously associated with EF enhancement, on EF. Method: Eighty University students, Hebrew monolinguals and Russian Hebrew bilinguals, with and without ADHD participated. Inhibition tasks were a Numeric Stroop task and a Simon arrows task. Shifting tasks were the Trail Making Test (TMT) and a task-switching paradigm. Results: Participants with ADHD performed worse than controls, but we did not find a bilingual advantage in EF. The negative impact of ADHD was more pronounced for bilinguals than for monolinguals, but only in interference suppression tasks. Bilingual participants with ADHD had the lowest performance. Conclusion: Bilingualism might prove to be an added burden for adults with ADHD, leading to reduced EF abilities. Alternatively, the current findings might be ascribed to over- or under-diagnosis of ADHD due to cultural differences between groups. These issues should be pursued in future research.
Objective: The Pediatric Attention Disorders Diagnostic Screener (PADDS) is an evidence-based screener of attention and executive functioning that combines computer-based Target Tests of Executive Function (TTEFs; Target Recognition, Target Sequencing, and Target Tracking) with parent and teacher behavioral reports to efficiently screen children ages 6 to 12 for ADHD. The present study is the first to examine the utility of the TTEFs in predicting ADHD status. Method: The PADDS TTEFs were administered to 76 children (age = 6-12) with ADHD and 76 matched controls. Logistic regression and diagnostic efficiency statistics were used to evaluate the ability of the three TTEFs to predicted ADHD status. Results: All three TTEFs significantly discriminated ADHD participants from controls, but each had a different diagnostic efficiency profile. Classification accuracy was improved when results of all three TTEFs were combined. Conclusion: The PADDS is a promising tool for quickly and reliably screening for ADHD in clinic and school settings.
Objective: It has been reported that Oppositional Defiant Disorder (ODD) can be differentiated into distinct subtypes associated with different outcomes in adulthood. We examined whether ODD is conceptually independent and coherent, and whether ODD and Conduct Disorder (CD) are expressions of the same core deficit. Method: The data come from a sample of 4,380 children for whom SNAP rating scales were available. Parallel analysis was performed on the eight-item ODD diagnostic items and on the SNAP-90 scale. These were factor analyzed and the components were correlated. Results: ODD has one underlying factor, whereas the parent-rated SNAP has nine underlying factors. ODD items grouped together with emotional lability and irritability items, which did not group with CD. Confirmatory factor analysis supported the separation of ODD and CD but not ODD and emotion dysregulation. Conclusion: The expanded ODD factor more likely captures a disorder of emotion regulation, rather than a disruptive behavior disorder. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.
Objective: Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) A-criteria for ADHD were expanded to include new descriptors referencing adolescent and adult symptom manifestations. This study examines the effect of these changes on symptom endorsement in a sample of adolescents with ADHD (N = 259; age range = 10.72-16.70). Method: Parent ratings were collected and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) and DSM-5 endorsement of ADHD symptoms were compared. Results: Under the DSM-5, there were significant increases in reported inattention, but not hyperactivity/impulsivity (H/I) symptoms, with specific elevations for certain symptoms. The average adolescent met criteria for less than one additional symptom under the DSM-5, but the correlation between ADHD symptoms and impairment was attenuated when using the DSM-5 items. Impulsivity items appeared to represent adolescent deficits better than hyperactivity items. Results were not moderated by demographic factors. Conclusion: In a sample of adolescents with well-diagnosed DSM-IV-TR ADHD, developmental symptom descriptors led parents to endorse slightly more symptoms of inattention, but this elevation is unlikely to be clinically meaningful.
Objective: In an effort to address the lack of evidence-based interventions for ADHD in developing South Asian countries, we examined the preliminary efficacy of a behavioral parent training program in Pakistan. Method: A quasi-experimental design was utilized. Eighty-five 4- to 12-year-old children with clinically significant ADHD symptoms participated: 55 were recruited from hospital clinics (active treatment group) and 30 were recruited from schools (waitlist control group). Parent and teacher ratings of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and impairment were collected. Results: Using intent-to-treat analyses, the treatment group showed significant pre–post improvement on parent-reported ODD symptoms and ADHD-related impairment. Teacher ratings showed no improvement. Conclusion: This study provides preliminary evidence for the feasibility and effectiveness of behavioral parenting training for children with ADHD in Pakistan and represents a critical first step in identifying evidence-based treatments for Pakistani children with ADHD.
Objective: Studies have suggested that even a single session of physical exercise enhances executive functions. ADHD is among the most common developmental disorders in childhood, but little is known about alternative treatments for this disorder. Therefore, we performed a systematic review of the literature to analyze articles that evaluated the executive functions of children with ADHD after an acute exercise session. Method: We reviewed articles indexed in the PubMed, American Psychiatric Association (APA) psychNET, Scopus, and Web of Knowledge databases between 1980 and 2013. Results: Of 231 articles selected, only three met the inclusion criteria. Conclusion: Based on these 3 articles, we concluded that 30 min of physical exercise reportedly improved the executive functions of children with ADHD. Due to the small number of articles selected, further studies are needed to confirm these benefits.
Objective: Although several studies suggest heritability of ADHD, only a few investigations of possible associations between people at risk and neural abnormalities in ADHD exist. In this study, we tested whether parents of children with ADHD would show atypical patterns of cerebral activations during forethought, a feature of working memory. Method: Using Functional Magnetic Resonance Imaging (fMRI), we compared 12 parents of children with ADHD and 9 parents of control children during a forethought task. Results: Parents of children with ADHD exhibited significantly increased neural activations in the posterior lobes of the cerebellum and in the left inferior frontal gyrus, relative to parents of control children. Conclusion: These findings are consistent with previous reports in children and suggest the fronto-cerebellar circuit’s abnormalities during forethought in parents of children with ADHD. Future studies of people at risk of ADHD are needed to fully understand the extent of the fronto-cerebellar heritability.
Objective: ADHD and post-traumatic stress disorder (PTSD) are often comorbid yet despite the increased comorbidity between the two disorders, to our knowledge, no data have been published regarding the neuropsychological profile of adults with comorbid ADHD and PTSD. Likewise, previous empirical studies of the neuropsychology of PTSD did not control for ADHD status. We sought to fill this gap in the literature and to assess the extent to which neuropsychological test performance predicted psychosocial functioning, and perceived quality of life. Method: Participants were 201 adults with ADHD attending an outpatient mental health clinic between 1998 and 2003 and 123 controls without ADHD. Participants completed a large battery of self-report measures and psychological tests. Diagnoses were made using data obtained from structured psychiatric interviews (i.e., Structured Clinical Interview for DSM-IV, Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiologic Version). Results: Differences emerged between control participants and participants with ADHD on multiple neuropsychological tests. Across all tests, control participants outperformed participants with ADHD. Differences between the two ADHD groups emerged on seven psychological subtests including multiple Wechsler Adult Intelligence Scale—Third edition and Rey-Osterrieth Complex Figure Test measures. These test differences did not account for self-reported quality of life differences between groups. Conclusion: The comorbidity with PTSD in adults with ADHD is associated with weaker cognitive performance on several tasks that appear related to spatial/perceptual abilities and fluency. Neuropsychological test performances may share variance with the quality of life variables yet are not mediators of the quality of life ratings. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: We investigated whether volumetric differences in ADHD-associated brain regions are related to current symptoms of inattention and hyperactivity in healthy middle-aged adults and whether co-occurring anxiety/depression symptoms moderate these relationships. Method: ADHD Self-Report Scale and Brief Patient Health Questionnaire were used to assess current symptoms of inattention, hyperactivity, anxiety, and depression in a population-based sample (n = 269). Brain volumes, measured using a semi-automated method, were analyzed using multiple regression and structural equation modeling to evaluate brain volume–inattention/hyperactivity symptom relationships for selected regions. Results: Volumes of the left nucleus accumbens and a region overlapping the dorsolateral prefrontal cortex were positively associated with inattention symptoms. Left hippocampal volume was negatively associated with hyperactivity symptoms. The brain volume–inattention/hyperactivity symptom associations were stronger when anxiety/depression symptoms were controlled for. Conclusion: Inattention and hyperactivity symptoms in middle-aged adults are associated with different brain regions and co-occurring anxiety/depression symptoms moderate these brain–behavior relationships. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: The present study aimed to investigate aspects of health and motivation in a subpopulation of college students with ADHD. Method: Seventy-seven college students with self-reported ADHD (49 women; M age = 25.82, SD = 4.62) and 120 college students without ADHD (65 women; M age = 25.17, SD = 5.41) participated in an online survey assessing their health, dietary habits, and achievement motivation. Results: College students with ADHD showed impairment in psychological functioning, impairment in their mental health, and reported more ambition and less self-control. Furthermore, we found gender differences: Women with ADHD reported worse psychological functioning, and the gender differences in obsessive-compulsive behavior and compensatory effort were mediated by the timing of diagnosis. Conclusion: College students, especially women, with ADHD struggle with health-related issues. Some of these gender differences might be due to under diagnosis of girls in childhood. Differences in achievement motivation might indicate compensatory mechanisms. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To investigate the change of ADHD medication prescriptions in Turkey between 2009 and 2013. Method: Consumption data of ADHD medications, immediate release (IR) methylphenidate (MPH; Ritalin), OROS MPH (Concerta), and atomoxetine (Strattera) were obtained from IMS Health database for the November 2008 to October 2013 period. Defined daily dose (DDD) of each drug was calculated according to WHO definitions and time-series analysis was conducted. Results: There was a significant seasonal effect for prescription of all drugs. Annual use of ADHD medications increased 2.18 times for all ADHD medications combined. DDDs per 1,000 population per day for all ADHD medications were 0.28 in 2009, 0.41 in 2010, 0.52 in 2011, and 0.59 in 2012. OROS MPH represented almost 75% of all ADHD medication utilization. Conclusion: As reported from several other countries, ADHD medication use increased in Turkey. Results suggested that over- and underdiagnosis might be seen at the same time. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To develop an understanding of the meanings and consequences of a diagnosis of ADHD for young people during the transition from childhood to adolescence. Method: Nine youth with an ADHD diagnosis were interviewed using a semi-structured interview guide on topics of management of identity and their own experiences of their difficulties relating to ADHD. Results: The meanings and consequences of the ADHD diagnosis is best understood in terms of overall identity development and social connectedness. In addition, cultural understandings of what ADHD is play a major role in negotiating the role of ADHD in identity. Conclusion: Youth with ADHD moving from childhood to adulthood need support for identity development. Health care professionals should be aware of young people’s experiences of ADHD symptoms in the context of their life situations and the cultural understanding of ADHD during treatment and psychoeducation. (J. of Att. Dis. 2014; XX(X) 1-XX)
Objective: To investigate the effects of social-skills training and a parental training program on children with ADHD as measured by the children’s attachment competences. Method: The SOSTRA trial is a randomized, parallel-group, outcome-assessor-blinded, superiority trial evaluating 8 weeks social-skills training and parental training plus standard treatment versus standard treatment alone for 8- to 12-year old children with ADHD. Results: There were no significant differences in attachment competences at 6 months between the experimental (n = 25) and the control (n = 22) groups (odds ratio = 1.06, 95% confidence interval = [0.31, 3.58], p = .91). In total, 17 children (36%) changed their entry status, 1 (2%) from secure to insecure attachment, while 16 (34%) changed from insecure to secure attachment. Conclusion: The experimental treatment does not seem to affect attachment competences compared with standard treatment alone. Children in the SOSTRA trial improved their attachment competences significantly at 6-month follow-up. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To identify ADHD symptoms that are most highly predictive of ADHD diagnostic status and compare them against Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) algorithms in predictions of functional impairment. Method: Parent and teacher ratings of ADHD were obtained from an ethnically diverse (46% non-White) sample of 151 five- to ten-year-old children (27% female) with (n = 76) and without (n = 75) DSM-IV ADHD. We calculated total predictive values to estimate how ratings of each ADHD symptom predicted ADHD diagnostic status based on a structured parent diagnostic interview. Optimal symptom thresholds (i.e., not at all, just a little, pretty much, very much) for predicting ADHD caseness differed for inattention and hyperactivity and parents versus teachers. Algorithms consisting of highly predictive symptoms were then created and compared against DSM-IV-based algorithms to predict independent measures of functional impairment. Results: Several empirically derived symptom algorithms were more strongly associated with functional impairment than DSM-IV-based algorithms. Conclusion: These preliminary findings suggest that alternative methods to aggregating ADHD symptoms may improve predictions of impairment. (J. of Att. Dis. 2014; XX(X) 1-XX)
Objective: ADHD is associated with increased academic and social difficulties and comorbid psychopathology which may lead to decreased life satisfaction (LS). Methods: The current study utilized a bifactor model of ADHD consisting of a general factor and two specific factors (inattention and hyperactivity-impulsivity) to determine if ADHD symptoms place middle school students (n = 183) at risk for diminished LS and if this relationship differed depending on whether teachers versus students reported ADHD symptoms. Results: Confirmatory factor analyses indicated that the bifactor model provided very good fit to the ADHD symptoms reported by students (comparative fit index [CFI] = .995; root mean square error of approximation [RMSEA] = .028) and teachers (CFI = .997; RMSEA = .043). Results also demonstrated that when students rated ADHD symptoms, the general ADHD factor and inattention were negatively related to LS; however, when teachers rated ADHD symptoms, only inattention was negatively related to LS. Conclusions: Implications and future directions related to these results are discussed. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To assess the accuracy of electronic health record (EHR)–derived diagnoses in identifying children with incident (i.e., newly diagnosed) ADHD. Method: In 10 large health care organizations, electronic diagnoses data were used to identify all potential cases of incident ADHD among 3- through 9-year-old children. A random sample of records was manually reviewed to determine whether a diagnosis of ADHD was documented in clinician notes. Results: From electronic diagnoses data, a total of 7,362 children with incident ADHD were identified. Upon manual review of 500 records, the diagnosis of incident ADHD was confirmed in clinician notes for 71.5% (95% confidence interval [CI] = [56.5, 86.4]) of records for 3- through 5-year-old children and 73.6% (95% CI = [65.6, 81.6]) of records for 6- through 9-year-old children. Conclusion: Studies predicated on the identification of incident ADHD cases will need to carefully consider study designs that minimize the likelihood of case misclassification. (J. of Att. Dis. 2014; XX(X) 1-XX)
Objective: Despite growing awareness of adult ADHD and its comorbidity with personality disorders (PDs), little is known about sex- and subtype-related differences. Method: In all, 910 patients (452 females, 458 males) affected with persistent adult ADHD were assessed for comorbid PDs with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire. Results: The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type. Conclusion: Sex- and subtype-related differences in Axis II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: This study examined the effects of the OutSMARTers program on social skills, self-regulation, and executive functions compared with a Waitlist group and a parent training program. Method: Participants were 41 children with ADHD, aged 8 to 10 years. All groups were assessed with behavioral checklists and neuropsychological measures at baseline and post-treatment. The two treatment groups were reassessed with behavioral checklists after 3 months. Results: Findings revealed decreased ADHD symptoms, improved social skills, and better emotion regulation at post-treatment for the OutSMARTers compared with the Waitlist group on subjective measures. No differences were found on objective tasks or between the OutSMARTers and Parent groups after treatment but both treatment groups showed some improvement. In addition, most of the post-treatment changes were maintained for both groups 3 months later. Conclusion: The results indicate that the OutSMARTers program seems to benefit children with ADHD, but further research and treatment development is needed. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To explore the subjective quality of life (QoL) in children with Tourette Syndrome (TS) in China to provide a basis for more effective interference. Method: A total of 107 patients and 107 controls were enrolled. Subjective QoL was investigated by Inventory of Subjective Life Quality, Family Environment Scale of Chinese Version, and the Yale Global Tic Severity Scale, and a case–control study was performed. Results: The total score of subjective QoL and family life, school life, peer relationship, cognitive component, environment, self-awareness, cognitive component and depression experience in the TS were lower than control. Patients with co-morbid exhibited significantly lower scores within the subjective QoL family life, peer relationship, school life, self-awareness, and cognitive affective domains. Conclusion: The subjective QoL is impaired and it is important to control clinical symptoms and improve family environment for the improvement of the subjective QoL in TS. (J. of Att. Dis. XXXX; XX(X) 1-XX)
Objective: ADHD appears to increase risk for both depression and suicidal ideation, while ADHD and depression are also associated with emotion regulation deficits. Thus, we evaluated the degree to which depression mediated the association between ADHD and suicidal ideation, as well as the degree to which emotion regulation deficits moderated the association ADHD shared with depression and suicidal ideation in a nonclinical sample. Method: Participants were undergraduate psychology students (N = 627; age: M = 20.23, SD = 1.40; 60% female; 47% European American) who completed an online assessment. Results: Results indicated that ADHD indirectly increased suicidal ideation through depression. Emotion regulation deficits of accepting negative emotions, emotional awareness, and goal-oriented behavior moderated the indirect effect of ADHD on suicidal ideation. Conclusion: Depression appears to play an important mediating role in suicidal ideation for college students with ADHD, and specific emotion regulation deficits appear to amplify the effects of ADHD on depression and suicidal ideation. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: This study aims to ascertain once and for all whether children and adolescents affected by ADHD show a higher risk for accidents, as well as investigating a possible association between the administration of ADHD-specific medication and the occurrence of accidents. Method: Two exceptionally large sets of data were implemented in this analysis. Participants included children and adolescents representative of the entire German population. Data for Survey 1 was collected through extensive administration of questionnaires. Data for Survey 2 stemmed from the records of a leading German health insurance company. In terms of statistical analysis, chi-square tests as well as logistic regression analyses were applied and odds ratios (ORs) were determined. Results: Innovative results are presented showing a significantly higher likelihood for ADHD-affected youngsters to be involved in accidents compared with their nonaffected counterparts (Survey 1: OR = 1.60; Survey 2: OR = 1.89) but lacking an overall significant influence of medication regarding the occurrence of accidents (Survey 1: OR = 1.28; Survey 2: OR = 0.97). Frequency of accidents could be predicted by ADHD, gender, and age in both samples. Medication intake served as a weak predictor only in Survey 2. Conclusion: It has been determined in two representative and independent German samples that youngsters with ADHD are at a significantly higher risk of being involved in accidents. In the future, this should always be considered when setting up a treatment plan to ensure a safer and healthier coming of age without relying solely on specific effects of medication. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. Method: Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. Results: In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). Conclusion: A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To compare efficacy of Omega-3/6 fatty acids (Equazen eye q™) with methylphenidate (MPH) and combined MPH + Omega-3/6 in children with ADHD. Method: Participants (N = 90) were randomized to Omega-3/6, long-acting MPH, or combination for 12 months. ADHD symptoms were assessed using the ADHD Rating Scale and Clinical Global Impressions–Severity (CGI-S) scale. Results: ADHD symptoms decreased in all treatment arms. Although significant differences favoring Omega + MPH over Omega-3/6 alone were found for ADHD Total and Hyperactivity-Impulsivity subscales, results on the Inattention subscale were similar. CGI-S scores decreased slowly and consistently with Omega-3/6, compared with a rapid decrease and subsequent slight increase in the MPH-containing arms. Adverse events were numerically less frequent with Omega-3/6 or MPH + Omega-3/6 than MPH alone. Conclusion: The tested combination of Omega-3/6 fatty acids had similar effects to MPH, whereas the MPH + Omega combination appeared to have some tolerability benefits over MPH.
Objective: To examine the level of agreement between self- and observer-reported ratings of ADHD symptoms and executive function (EF) behaviors in adults with moderate to severe ADHD and EF deficits. Method: During a 10-week, randomized, double-blind, placebo-controlled study, the effect of lisdexamfetamine dimesylate (LDX) on EF was assessed by self-report and informant report (Behavior Rating Inventory of Executive Function–Adult Version), and ADHD symptoms were assessed by clinician- and informant-rated scales (ADHD Rating Scale IV with adult prompts and Conners’ Adult ADHD Rating Scales–Observer Report: Short Version, respectively). Post hoc analysis used Pearson correlations to assess relationships between self- and informant-rated EF and clinician- and informant-rated ADHD symptoms. Results: Correlations between self-ratings versus informant ratings and clinician versus informant ratings were greater at Week 10/early termination (EF: placebo [0.5231–0.6085], LDX [0.3543–0.5167]; ADHD symptoms: placebo [0.4169], LDX [0.4004]) versus baseline (EF: placebo [0.3208–0.5023], LDX [0.2852–0.3439]; ADHD symptoms: placebo [0.1511], LDX [–0.0408]). Conclusion: LDX improved EF and ADHD symptoms, based on participant, informant, and clinician ratings. Increased rater agreement over time may reflect improved symptom awareness. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Little is known about perceptions surrounding academic interventions for ADHD that determine intervention feasibility. Method: As part of a longitudinal mixed-methods research project, representative school district samples of 148 adolescents (54.8%), 161 parents (59.4%), 122 teachers (50.0%), 46 health care providers (53.5%), and 92 school health professionals (65.7%) completed a cross-sectional survey. They also answered open-ended questions addressing undesirable intervention effects, which were analyzed using grounded theory methods. Results: Adolescents expressed significantly lower receptivity toward academic interventions than adult respondents. Stigma emerged as a significant threat to ADHD intervention feasibility, as did perceptions that individualized interventions foster inequality. Conclusion: Findings suggest that adolescents’ viewpoints must be included in intervention development to enhance feasibility and avoid interventions acceptable to adults, but resisted by adolescents. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Empirical evidence on prospective memory (PM) in ADHD is inconsistent. Differential findings have been related to differential executive control demands. This study aimed at exploring the impact of inhibitory control on event-based PM performance in ADHD. Method: Eighteen adults with ADHD and 18 controls performed a word categorization task with an embedded event-based PM task. In addition, participants performed an acoustically presented task that put either low or high loads on inhibitory control processes. Results: Inhibitory load did not differentially affect PM performance: Across both inhibitory load conditions, individuals with ADHD showed reduced PM performance when compared with controls. Moreover, inhibitory load did not influence PM performance across both groups. Conclusion: Possibly, full inhibitory control resources are not necessary during the entire duration of an event-based PM task, but may suffice to be employed after cue detection when needing to interrupt the ongoing task. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim of the study was to investigate the pattern of neuropsychological profiles on the Wechsler Adult Intelligence Scale–IV (WAIS-IV) for ADHD adults relative to randomly matched controls and to assess overall intellectual ability discrepancies of the Full Scale Intelligence Quotient (FSIQ) and the General Ability Index (GAI). Method: In all, 116 ADHD adults and 116 controls between 16 and 71 years were assessed. Results: Relative to controls, ADHD adults show significant decrements in subtests with working memory and processing speed demands with moderate to large effect sizes and a higher GAI in comparison with the FSIQ. Conclusion: This suggests first that deficits identified with previous WAIS versions are robust in ADHD adults and remain deficient when assessed with the WAIS-IV; second that the WAIS-IV reliably differentiates between patients and controls; and third that a reduction of the FSIQ is most likely due to a decrement in working memory and processing speed abilities. The findings have essential implications for the diagnostic process. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: A failure of the anti-phase synchronization between default-mode (DMN) and task-positive networks (TPN) may be involved in a main manifestation of ADHD: moment-to-moment variability. The study investigated whereby methylphenidate may improve TPN/DMN synchronization in ADHD. Method: Eleven drug-naive ADHD children and 11 typically developing (TD) children performed a flanker task during functional magnetic resonance imaging. The ADHD group was scanned without and 1 month later with methylphenidate. The signal was analyzed by independent component analysis. Results: The TD group showed anti-phase DMN/TPN synchronization. The unmedicated ADHD group showed synchronous activity in the posterior DMN only, which was positively correlated with response time variability for the flanker task. Methylphenidate initiated a partial anti-phase TPN/DMN synchronization, reduced variability, and abolished the variability/DMN correlation. Conclusion: Although results should be interpreted cautiously because the sample size is small, they suggest that a failure of the TPN/DMN synchronization could be involved in the moment-to-moment variability in ADHD. Methylphenidate initiated TPN/DMN synchronization, which in turn appeared to reduce variability. (J. of Att. Dis. 2014; XX(X) 1-XX)
Objective: The aim was to examine associations of age and gender with ADHD subtypes and subsequently to examine associations of age, gender, and subtypes with comorbid psychiatric disorders. Method: Odds ratios were calculated and logistic regression performed using information from a clinical sample of 155 ADHD adults referred to a Danish specialized ADHD unit from 2010 to 2011. Results: A majority of men (65%) was found in the sample. Most patients were subtyped ADHD combined (78%), followed by ADHD inattentive (18%), and ADHD hyperactive-impulsive (4%). No significant differences were found in gender and age across subtypes. Current comorbid disorders were found in 57% of the ADHD patients. Significantly more comorbidity was found in the ADHD combined type and in patients ≥25 years. Significantly more men had substance use disorders and significantly more women had personality disorders. Conclusion: When assessing adult ADHD patients’ age, gender, subtype, and related comorbid symptom profiles should be taken into account. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: The purpose of this quantitative survey study is to provide current accurate estimates of the number of students with ADHD in Qatar Independent and English Medium Private Schools, so that adequate support will be available to assist in the educational growth and development of these students. Method: This cross-sectional descriptive study of teacher observational ratings used a standardized rating scale. Teachers completed the SNAP-IV. Rating Scales for more than 5,000 students from Qatar Independent Schools and private English Medium Schools between November 2011 and November 2012 in Qatar Grades 1 through 12. Results: Results align with and extend the previous study of ADHD in Qatar and the current worldwide prevalence. Conclusion: Enhanced analyses were conducted to identify differences between age groups, genders, and between Private and Independent Schools. Implications for teachers, administrators, and medical personnel are discussed. (J. of Att. Dis. XXXX; XX(X) X-XX)
Objective: We describe interactions among factors that contribute to the development of conduct problems among children with ADHD. Method: An integrative developmental psychopathology analysis combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD. Results: Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child’s conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory. Conclusion: In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: We examined the presence of cerebellar symptoms in ADHD and their association with behavioral markers of this disorder. Method: Sixty-two children with ADHD and 62 typically developing (TD) children were examined for cerebellar symptoms using the ataxia rating scale and tested using Conners’ Continuous Performance Test. Results: Children with ADHD had significantly more cerebellar symptoms compared with the TD children. Cerebellar symptom scores decreased with age in the ADHD group; in the TD group remained stable. In both groups, cerebellar symptoms were associated with parent-rated hyperactive/impulsive symptoms, variability of response time standard error (RT-SE) and increase of RT-SE as the test progresses. More variables were associated with cerebellar symptoms in the ADHD group including omission errors, overall RT-SE and its increase for prolonged interstimulus intervals. Conclusion: Our results highlight the importance of research into motor functions in children with ADHD and indicate a role for cerebellar impairment in this disorder. (J. of Att. Dis. XXXX; XX(X) 1-XX)
Objective: Using a population-based sample of 9-year-old children, this study examined whether the relation between symptoms of ADHD and executive functions (EFs) depended on socioeconomic status (SES; indexed by parental education). Method: Parents and teachers rated the children’s ADHD symptoms, and parents also indicated their educational level in a questionnaire. The children performed a comprehensive set of EF tasks. Results: Whereas working memory was similarly related to ADHD symptoms in the lower and higher parental education group, the relations of inhibition and mental set-shifting with ADHD symptoms were generally stronger in the higher educational group, a pattern that was supported by several significant group differences in correlations. Conclusion: This suggests that the EF pathway in contemporary multiple pathway models of ADHD etiology may be particularly relevant in higher SES parts of the population. (J. of Att. Dis. 2014; XX(X) 1-XX)
Objective: Attention capacities are critical for adaptive functioning and development. Reliable assessment measures are needed for the study of attention capacities in early childhood. In the current study, we investigated the factor structure of the Utrecht Tasks of Attention in Toddlers Using Eye-tracking (UTATE) test battery that assesses attention capacities in 18-month-old toddlers with eye-tracking techniques. Method: The factor structure of 13 measures of attention capacities, based on four eye-tracking tasks, was investigated in a sample of 95 healthy toddlers (18 months of age) using confirmatory factor analysis. Results: Results showed that a three-factor model best fitted the data. The latent constructs reflected an orienting, alerting, and executive attention system. Conclusion: This study showed support for a three-factor model of attention capacities in 18-month-old toddlers. Further study is needed to investigate whether the model can also be used with children at risk of attention problems. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim was to compare different scales capturing ADHD symptoms for older individuals’ self-reports about childhood and current ADHD symptomatology. An additional aim was relating these results to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD criteria. Method: The 25-item Wender Utah Rating Scale (WURS) administered in a population-based sample of 1,599 individuals aged 65 to 80. Two subsamples each with 30 individuals were randomly drawn based on their Wender Utah Rating Scale (WURS) scores, and studied using the Wender Riktad ADHD Symtom Skala (WRASS), interview assessed Barkley Scales, and DSM-IV ADHD criteria. Results: Higher WURS and WRASS scores were related to higher Barkley Childhood and Current Symptoms Scales Scores. Also, reporting more symptoms on these scales was related to meeting DSM-IV criteria for childhood and current ADHD. Conclusion: The results support significant persistence of ADHD symptoms when using different scales designed for the capture of childhood and current ADHD symptomatology. Further studies of ADHD in a lifespan perspective are encouraged. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: In recent years, the stigmatization faced by people with mental disorders has received considerable attention in the empirical literature. However, individuals with different disorders are subject to distinct types of negative attitudes, necessitating examinations of stigma that treat specific disorders individually. Method: This article reviews recent empirical literature concerning the stigmatization of ADHD. Further specificity is achieved by taking a developmental perspective, reviewing studies of stigmatizing attitudes as a function of the age of the target and perceiver. Results: Findings from nationally representative data sets, experimental investigations, surveys, and qualitative studies indicate that individuals of all ages who exhibit symptoms of ADHD are the recipients of substantial stigmatization. Conclusion: Although the stigmatizing attitudes of children and adolescents appear to differ in some ways from those of adults, negative perceptions toward people with ADHD appear to generally be present at all stages of development. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study used confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture model (FMM) to ascertain the best model for ADHD symptoms, as presented in the Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior Scale (SWAN). Method: Mother ratings of the ADHD symptoms of 418 clinic-referred children and adolescents were obtained. Results: The findings provided most support for an FMM with two classes (less severe inattention [IA] and hyperactivity/impulsivity [HI] symptoms and more severe IA/HI symptoms) and two factors (IA and HI) model. The more severe class had more individuals with the ADHD diagnosis, especially the combined type. Conclusion: The findings are discussed in relation to dimensional and categorical views of ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Few studies of ADHD prevalence have used population-based samples, multiple informants, and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Moreover, children who are asymptomatic while receiving ADHD medication often have been misclassified. Therefore, we conducted a population-based study to estimate the prevalence of ADHD in elementary school children using DSM-IV criteria. Method: We screened 7,587 children for ADHD. Teachers of 81% of the children completed a DSM-IV checklist. We then interviewed parents using a structured interview (DISC). Of these, 72% participated. Parent and teacher ratings were combined to determine ADHD status. We also estimated the proportion of cases attributable to other conditions. Results: Overall, 15.5% of our sample met DSM- (4th ed.; text rev., DSM-IV-TR) criteria for ADHD (95% CI [14.6%, 16.4%]); 42% of cases reported no previous diagnosis. With additional information, other conditions explained 9% of cases. Conclusion: The prevalence of ADHD in this population-based sample was considerably higher than 3% to 7%. To compare study results, the DSM criteria need standardization. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To dissociate between inattentive and impulsive traits common in attention deficit hyperactivity disorder (ADHD) using a non-dichotomous measurment of these traits. Method: 120 university students who completed the Conner’s adult ADHD rating scales (CAARS) were also tested on the Microgenesis task which requires visual attention and on the Cyber Cruiser task which requires emotion regulation. Results show that a measure of inattention was specifically related to a measure of effortful visual processing condition. In addition, a measure of impulsivity was specifically related to the tendency to fail in refueling one’s car on time, although this relation was opposite to the predicted direction. Furthermore, by using exploratory and confirmatory factor analyses, the CAARS’ factor structure was confirmed to be relevant to an Israeli population. Discussion: The current experiment supports the idea that visual attention may play a part in inattentive symptoms, and that emotion regulation may play a part in impulsivity symptoms.
Objective: Mindfulness meditation training is garnering increasing empirical interest as an intervention for ADHD in adulthood, although no studies of mindfulness as a standalone treatment have included a sample composed entirely of adults with ADHD or a comparison group. The aim of this study was to assess the feasibility, acceptability, and preliminary efficacy of mindfulness meditation for ADHD, executive functioning (EF), and emotion dysregulation symptoms in an adult ADHD sample. Method: Adults with ADHD were stratified by ADHD medication status and otherwise randomized into an 8-week group-based mindfulness treatment (n = 11) or waitlist group (n = 9). Results: Treatment feasibility and acceptability were positive. In addition, self-reported ADHD and EF symptoms (assessed in the laboratory and ecological momentary assessment), clinician ratings of ADHD and EF symptoms, and self-reported emotion dysregulation improved for the treatment group relative to the waitlist group over time with large effect sizes. Improvement was not observed for EF tasks. Conclusion: Findings support preliminary treatment efficacy, though require larger trials. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Tic disorders such as Gilles-de-la-Tourette syndrome (TS) are associated with difficulties in withholding movements and sometimes inappropriate actions. The present study examined whether these disorders lead to a specific difficulty in withholding preprogrammed voluntary movements irrespective of decisions on whether or not to move. Method: Children with TS with or without attention-deficit hyperactivity disorder (ADHD) and controls performed a fast-paced simple reaction time task involving responses to a target in a rapid letter stream (9 letters/s, average foreperiod 332 ms) with feedback on response speed. Results: The ADHD group showed more premature responses and more variable response time than other groups, whether the timing of the target was predictable or not. Conclusion: The data indicate that in tic disorders, the presence of ADHD is associated with difficulties in waiting to initiate preprogrammed movements independently of response selection or response timing difficulties. (J. of Att. Dis. 2013; XX(X) X-XX)
Objective: Children with ADHD have an increased risk of later developing personality disorders and criminal behavior. The object of the present review is to analyze the associations between ADHD and antisocial personality disorder (ASPD). Method: A review of literature was done using EMBASE, PsycINFO, and Medline databases. Results: Eighteen prospective studies (n = 5,501) showed that ADHD with and without comorbid conduct disorder (CD) is a strong predictor for the risk of later development of antisocial personality disorder (ASPD). Some of the 13 cross-sectional/retrospective studies (n = 2,451) suggested that ADHD and CD might be a separate subtype of ADHD, that especially impulsivity in ADHD is a predictor for later development of ASPD, or that callous-unemotional traits in the ADHD children are called for a risk factor for later ASPD. Conclusion: There is an increased risk for children with ADHD with or without comorbid CD to develop later onset of antisocial personality disorder. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: There is a significant negative relation between externalizing behavior and emergent literacy skills among preschool children. Method: The purpose of this study was to examine the impact of gender on the predictive relation of externalizing behavior and emergent literacy in a group of 178 preschool children (mean age = 48.50 months, SD = 3.66; 48% boys). Results: Externalizing behaviors predicted emergent literacy over time. Distinct patterns of predictive associations dependent on gender were found. Girls with higher levels of externalizing behaviors experienced less change in their vocabulary skills compared with the vocabulary change shown by girls with lower levels of these problem behaviors. Conclusion: The results suggest that early identification programs that include externalizing behavior problems and their relation with emergent literacy development should account for potential gender differences. A theoretical framework in which girls with behavior problems receive less opportunity for vocabulary acquisition is presented. (J. of Att. Dis. XXXX; XX(X) X-XX)
Objective: This study investigates whether performance in a verbal response task (Color-Word Interference Test [CWIT]) and a motor response task (Conners’ Continuous Performance Test [CCPT]) discriminates children with Tourette’s Syndrome (TS), ADHD, and typically developing children (TDC). Method: Nineteen children with TS, 79 with ADHD, and 50 with TDC participated (8-17 years). Results: Children with TS committed significantly fewer errors in the verbal response task than those with ADHD. Moreover, children with TS but without ADHD performed better than TDC. Errors in motor task and speed of response did not distinguish between groups. A cautious tendency of response correlated positively with rates of tics in children with TS. Conclusion: Children with TS were superior in inhibiting a prepotent verbal response; however, comorbidity with ADHD in those children negatively influenced performance. Results support the hypothesis that levels of inhibitory control distinguish children with TS, ADHD, and TDC. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: This study investigated behavioral and emotional characteristics of children with convergence insufficiency (CI), before and after treatment with office-based vergence accommodative therapy (OBVAT). Method: Parents of 44 children ages 9 to 17 years with symptomatic CI completed the Conners 3 ADHD Index and the Child Behavior Checklist (CBCL) before and after OBVAT. Pre-treatment scores were compared with normative data and post-treatment scores were compared with baseline using the Wilcoxon sign rank test. Results: Following OBVAT, CI children showed a significant mean improvement (p < .0001, effect size of 0.58) on the Conners 3 ADHD Index with the largest changes occurring in the 23 children who scored the highest at baseline. On the CBCL, anxious/depressed, somatic, and internalizing problems improved significantly (p < .001, effect sizes of –0.36, –1.15, and –0.67, respectively). Conclusion: In an open trial, attention and internalizing problems improved significantly following treatment for CI. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures. Method: Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI. Results: The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD). Conclusion: It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To clarify the role of oxidative stress and antioxidant activity in ADHD. Method: We examined the association of ADHD and oxidative stress by applying random effects meta-analysis to studies of oxidative stress and antioxidant status in medication naive patients with ADHD and controls. Results: Six studies of a total of 231 ADHD patients and 207 controls met our selection criteria. The association between ADHD and antioxidant status was not significant. We found a significant association between ADHD and oxidative stress that could not be accounted for by publication bias. The significant association lost significance after correcting for intrastudy clustering. No one observation accounted for the positive result. Conclusion: These results are preliminary given the small number of studies. They suggest that patients with ADHD have normal levels of antioxidant production, but that their response to oxidative stress is insufficient, leading to oxidative damage. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. Method: We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. Results: Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. Conclusion: Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented. (J. of Att. Dis. XXXX; XX(X) XX-XX)
A cross-sectional study was carried out to examine the pattern of changes in the capacity to coordinate attention between two simultaneously performed tasks in a group of 570 volunteers, from 5 to 17 years old. The results revealed that the ability to coordinate attention increases with age, reaching adult values by age 15 years. Also, these results were compared with the performance in the same dual task of healthy elderly and Alzheimer disease (AD) patients found in a previous study. The analysis indicated that AD patients showed a lower dual-tasking capacity than 5-year-old children, whereas the elderly presented a significantly higher ability than 5-year-old children and no significant differences with respect to young adults. These findings may suggest the presence of a working memory system’s mechanism that enables the division of attention, which is strengthened by the maturation of prefrontal cortex, and impaired in AD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To investigate the relationship between ADHD symptoms, executive functioning problems, and benefit from extended time testing accommodations. Method: College students completed a battery of measures assessing processing speed and reading fluency, reading comprehension (under two different time limits), symptoms of ADHD, executive functioning deficits, and perceptions of need for extended time. Results: Students reporting more symptoms of ADHD and executive functioning deficits actually benefited less from extended time, and students’ perceptions of their timing needs did not predict benefit. Conclusion: Students with more ADHD symptoms are less likely to use extended time effectively, possibly because of their associated executive functioning problems. These results suggest there may be little justification for examining a student’s ADHD symptoms when making extended time accommodation decisions. (J. of Att. Dis. 2013; XX(X) XX-XX)
Objective: Children with ADHD have heterogeneous behavioral and neuropsychological profiles. The aim of this study was to examine the possible utility of executive function (EF) subtypes within ADHD. Method: Participants were 357 children aged 6 through 13 with a diagnosis of ADHD. Children completed a brief laboratory battery measuring EF, including response inhibition, response variability, speed, and set-shifting. Children also completed standardized intelligence and achievement testing. Results: Two-way cluster analysis of EF profiles of children with ADHD produced a three-cluster solution, labeled poor inhibitory control, poor set-shifting/speed, and intact task performance. Clusters significantly differed in measures of intelligence, academic achievement, and other disruptive behavior and anxiety/mood symptoms. Conclusion: These findings further support the idea that children with ADHD have heterogeneous EF profiles and suggest that the theory of ADHD should consider these individual differences in EF profiles within the ADHD diagnostic category. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To investigate effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on attention, literacy, and behavior in children with ADHD. Method: Ninety children were randomized to consume supplements high in EPA, DHA, or linoleic acid (control) for 4 months each in a crossover design. Erythrocyte fatty acids, attention, cognition, literacy, and Conners’ Parent Rating Scales (CPRS) were measured at 0, 4, 8, 12 months. Results: Fifty-three children completed the treatment. Outcome measures showed no significant differences between the three treatments. However, in children with blood samples (n = 76-46), increased erythrocyte EPA + DHA was associated with improved spelling (r = .365, p < .001) and attention (r = –.540, p < .001) and reduced oppositional behavior (r = –.301, p < .003), hyperactivity (r = –.310, p < .001), cognitive problems (r = –.326, p < .001), Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) hyperactivity (r = –.270, p = .002) and DSM-IV inattention (r = –.343, p < .001). Conclusion: Increasing erythrocyte DHA and EPA via dietary supplementation may improve behavior, attention, and literacy in children with ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: The efficacy and safety of atomoxetine was assessed in adult ADHD patients from Japan, Korea, and Taiwan in this first placebo-controlled Asian clinical study in adults of an ADHD medication. Method: Atomoxetine was compared with placebo (195 atomoxetine, 196 placebo) over 10 weeks. The change from baseline to endpoint and changes over time in the Conners’ Adult ADHD Rating Scale–Investigator Rated: Screening Version total score (CAARS-Inv: SV total score) were assessed along with changes in quality of life (QoL) and executive function. Results: Atomoxetine treatment resulted in a mean reduction of –14.3 (placebo, –8.8) in CAARS-Inv: SV total score and a steady increase of between-group differences from Week 2. Improvements in QoL and executive functioning were also observed. Treatment-emergent adverse events leading to discontinuation were infrequent (atomoxetine: 5.2%, placebo: 1.5%). Conclusion: Atomoxetine was tolerable and effective in improving QoL and executive function as well as ameliorating core ADHD symptoms in adult Asian patients. (J. of Att. Dis. 2013; XX(X) XX-XX)
Objective: Many studies report on the usefulness of the evaluation of Executive Functions (EF) in the assessment of participants with ADHD, while others underline how deficits of EF in these participants are not consistent and that the same executive deficits are present in many other disorders, particularly in Asperger’s disorder. Using the Planning Attention Simultaneous Successive (PASS) theory, the present study explores the cognitive profiles of participants with ADHD or Asperger’s disorder and compares the cognitive functioning of these two diagnostic groups. Method: Forty-four children, 24 with a diagnosis of ADHD and 20 with a diagnosis of Asperger’s disorder, participated and their cognitive processes were evaluated with the Cognitive Assessment System. Results: Results underline specific cognitive profiles in ADHD and Asperger’s disorder characterized by weaknesses in planning and attention, but with a diverse level of severity. Conclusion: Implications of the different cognitive profiles of these diagnostic groups are discussed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. Method: A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. Results: Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. Conclusion: Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Adult ADHD is associated with impaired quality of life (QoL) and deficient executive function (EF). Given the absence of studies examining the relationship between EF and health-related quality of life (HRQL) in this population, the purpose of the present study was to do so, by the use of rating scales and tests. Method: Adults with ADHD (n = 81) completed ADHD and EF questionnaires and a neuropsychological battery. Results: Small to large significant correlations were found between EF ratings and HRQL for most of the variables. No significant correlations were found between all but one EF test and HRQL. Both ADHD symptoms and EF rating, but not the EF test, were found to have a unique contribution to the HRQL. Conclusion: These results strengthen the ecological validity of the EF rating scales and their utility in identifying EF deficits with real-world implications for adults with ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: We assessed the neural correlates of adult ADHD in treatment-naïve participants, an approach necessary for identifying neural substrates unconfounded by medication effects. Method: The sample consisted of 24 medication-naïve adults with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosed ADHD and 24 healthy controls, comparable on age, sex, handedness, reading achievement, IQ, and psychiatric comorbidity. All participants were assessed with structured diagnostic interviews. Magnetic resonance imaging (MRI)-based regional voxel-based morphometry (r-VBM) was used to assess volumetric differences in a priori defined brain regions of interest. Results: VBM analysis revealed group differences in the hypothesized cortical and subcortical areas; however, only cerebellar volume reductions in ADHD retained significance (p < .05) after corrections for multiple comparisons. Conclusion: These results support the notion that medication-naïve ADHD as expressed in adulthood, manifests subtle brain volume reductions from normal in the cerebellum, and possibly in other syndrome-congruent gray-matter structures. Larger samples are required to confirm these findings. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Patients with ADHD display a decreased contingent negative variation in Go/NoGo tasks. It is unclear whether the attenuation is due to deficits of executive function or to disorder of motor planning. The readiness potential (RP) recorded during self-initiated movements could cast light on this question. Method: RP was recorded in 25 stably medicated adult ADHD patients and 21 healthy controls matched for age, education, and verbal IQ. Participants also completed neuropsychological tests of executive function. Results: Compared with healthy controls, ADHD patients showed significantly diminished RP peaks and also decreased negativity in preparation of the movement at frontal locations. There were no significant group differences with regard to tests of executive function. Conclusion: In adults with ADHD, deficits of motor organization are also manifest in situations not involving external stimulus processing. The attenuated RP occurred in the absence of executive dysfunction. Results are consistent with partial independence between motor and executive dysfunction in ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To study reading performance of young adults with ADHD and its relation with executive functioning. Method: Thirty young adults with a childhood diagnosis of ADHD and 30 with normal development (ND) were compared on reading accuracy, fluency, and comprehension. Furthermore, ADHD with reading disabilities (ADHD+RD) and ADHD without reading disabilities (ADHD-RD) subgroups were compared using self-report and informant-report versions of the Behavior Rating Inventory of Executive Function–Adult version (BRIEF-A). Results: Adults with ADHD obtained significantly worse results than the ND adults on reading speed, responses to literal questions, and a cloze test. Although the comparison of the ADHD+RD and ADHD-RD groups did not show significant differences on the BRIEF-A subscales, the ADHD+RD group surpassed the critical percentile (85) on more subscales, with working memory and metacognition especially affected. Conclusion: The findings point out that reading should be assessed in individuals with ADHD as part of their evaluation to design effective early interventions. (J. of Att. Dis. XXXX; XX(X) XX-XX).
Objective: The aim of this study was to empirically determine subgroups of ADHD defined by specific patterns of psychopathology. Method: A clinical sample of 223 children with ADHD, aged 5 to 14 years, was examined with the Child Behavior Checklist (CBCL). In addition, comorbid psychiatric disorders, psychosocial risk factors, and socioeconomic status were assessed. Results: Cluster analysis of CBCL subscales yielded a solution with four distinct subgroups. While "externalizers" showed a high rate of comorbid oppositional defiant disorder (ODD) and conduct disorder (CD), "obsessive-compulsives" exhibited thought problems, low rates of comorbid CD, and high symptoms of inattention. "High psychiatric symptom carriers" had high rates of familial risk factors, acute life events, comorbid ODD, and CD. "Low psychiatric symptom carriers" also scored low in all other variables studied. Conclusion: Children with ADHD can be divided into four subgroups according to their CBCL-based psychopathology, and these subgroups differ in their risk factor profiles. (J. of Att. Dis. 2013; XX(X) XX-XX)
Objective: The findings of genetic, imaging and neuropsychological studies of attention-deficit hyperactivity disorder (ADHD) are mixed. To understand why this might be the case we use both dimensional and categorical symptom measurement to provide alternate and detailed perspectives of symptom expression. Method: Interviewers collected ADHD, conduct problems (CP) and sociodemographic data from 3793 twins and their siblings aged 22 to 49 (M = 32.6). We estimate linear weighting of symptoms across ADHD and CP items. Latent class analyses and regression describe associations between measured variables, environmental risk factors and subsequent disadvantage. Additionally, the clinical relevance of each class was estimated. Results: Five classes were found for women and men; few symptoms, hyperactive-impulsive, CP, inattentive, combined symptoms with CP. Women within the inattentive class reported more symptoms and reduced emotional health when compared to men and to women within other latent classes. Women and men with combined ADHD symptoms reported comorbid conduct problems but those with either inattention or hyperactivity-impulsivity only did not. Conclusion: The dual perspective of dimensional and categorical measurement of ADHD provides important detail about symptom variation across sex and with environmental covariates. (J. of Att. Dis. 2013; XX(X) XX-XX)
Objective: The aim of this study was to assess the impact of self-reported emotional and conduct problems on family functioning and quality of life (QoL) among adolescents with ADHD. Method: The ADHD group (N = 194) was divided into the following groups: without additional emotional or conduct problems, with emotional problems, with conduct problems, and with both problem types. The cross-sectional study included parent and adolescent reports. Results: Adolescents with ADHD and both problem types reported significantly lower QoL and family functioning than all other ADHD groups. Parents reported better QoL for the ADHD group without additional problems, but similar family functioning for all groups. Conclusion: A higher level of coexisting psychiatric problems had a significant impact on adolescents’ reports of family functioning and QoL. However, coexisting problems showed no association with parent reports of family functioning. Adolescents with ADHD might add important information in clinical assessment. (J. of Att. Dis. XXXX; XX(X) XX-XX).
This study examined whether the negative association between children’s attention difficulties and their academic functioning is largely confined to children whose attention problems persist across early grades and whether it depends on when attention problems emerge in children’s schooling. Children from the normative sample of the Fast Track study were classified into four attention problem groups based on the presence versus absence of attention problems in first and second grade. Those with attention problems in both grades showed a decline in reading and math achievement during the K-5 interval relative to children with attention problems in first grade only. Both groups of inattentive first graders also performed worse than comparison children. In contrast, children whose attention problems emerged in second grade did not differ from comparison children on any achievement outcome performed significantly better than inattentive first graders. The implications of these findings are discussed. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Given the paucity of research among prisoners, this study aimed to examine the prevalence and psychiatric comorbidity associated with adult ADHD. Method: The study was conducted at four NSW correctional facilities (2 male; 2 female). Results: Thirty-five percent of the sample screened positive for adult ADHD, and 17% of the sample met criteria for a full diagnosis. After adjustment, benzodiazepine dependence, borderline personality disorder, social phobia, antisocial personality disorder, and a number of lifetime psychological disorders remained significantly and independently associated with the diagnosis of adult ADHD. Lowering the threshold on the ADHD Self-Rating Scale to ≥3 (vs. ≥4) increased the sensitivity (80%-93%), but lowered the specificity (55%-47%). Conclusion: Adult ADHD among NSW prisoners is elevated, with substance use disorders and psychiatric comorbidity common. A greater acceptance of this disorder among prisoners, and appropriate treatment, is warranted. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: The aim was to investigate how well neuropsychological measures can discriminate between adults with ADHD and those with other psychiatric disorders. Method: Adults with ADHD and a clinical control group (n = 110) were included. Neuropsychological functioning was investigated using measures of inhibition, working memory, set shifting, planning, fluency, reaction-time variability, and delay aversion. Results: Adults with ADHD performed more poorly compared with clinical controls with regard to all constructs. The effects of verbal memory, inhibition, set shifting, fluency, and delay aversion remained significant when controlling for IQ. However, when controlling for basic cognitive functions, only the effects of inhibition, fluency, and delay aversion were significant. Sensitivity ranged between 64% and 75%, and specificity between 66% and 81%. Conclusion: Neuropsychological tests have a relatively poor ability to discriminate between adults with ADHD and clinical controls, but they may be used to identify individuals at particularly high risk for poor daily functioning. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To evaluate the information postsecondary institutions require when determining disability service eligibility for students with reported ADHD. Method: ADHD documentation requirements of 200 U.S. institutions were surveyed by reviewing guidelines posted on disability services websites. Results: Whereas virtually all institutions required documentation, findings revealed significant variability in requirements across institutions. Required variables most often included a qualified evaluator (80%), diagnostic statement (75%), and identification of substantial limitations (73%), but only 5 of 46 evaluated variables were required by at least 50% of institutions. Supportive data such as diagnostic criteria, standardized assessment results, and rationale for accommodations were rarely required. Conclusion: The majority of institutions required little to verify ADHD as a disability. Furthermore, there was little agreement on what components are essential for verification. When integrated with research, a large portion of guidelines failed to address identified weaknesses in ADHD diagnosis and disability determination. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: Analyze diagnostic and demographic factors to identify predictors of delinquency resulting in incarceration within a group of children/adolescents diagnosed with ADHD. Method: The study followed a cohort of 15,472 Medicaid covered children/adolescents with ADHD, ages 6 to 15 inclusive, between January 1, 2003, and December 31, 2006. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [DSM-IV-TR]), 2000 Codes were used for qualifying diagnosis codes. Available demographic characteristics included race, sex, and residence. The outcome was incarceration at the South Carolina Department of Juvenile Justice during 2005-2006. Results: Among youth with ADHD, incarceration was more likely among black, male, and urban youth. Children/adolescents with comorbid ODD and/or CD were at greater risk compared with those with ADHD alone. Conclusion: Within ADHD-diagnosed youth, comorbid conditions and demographic characteristics increase the risk of incarceration. Intervention and treatment strategies that address behavior among youth with these characteristics are needed to reduce incarceration.
Objective: Few studies assessed factors associated with the agreement/disagreement between fathers and mothers when rating ADHD symptoms of their offspring. Method: Teachers and both parents assessed a referred sample of 98 children and adolescents aged 6 to 16 years (M age = 9.79, SD = 2.59) using the Swanson, Nolan, and Pelham (SNAP-IV) rating scale. The agreement was assessed for each of the items of the scale and correlated with variables measuring children’s features, socioeconomic adversity, family functioning, and parental psychopathology. Results: Mean agreement between parents was moderate for the inattentive and good for the hyperactive-impulsive construct. Mothers tended to report more symptoms than fathers. The agreement was lower in those families where parents had discrepant educational levels. Conclusion: Our findings suggest a significant cross-informant disagreement between parents on symptoms of ADHD. Discrepant parental education has a relevant role in explaining parental disagreement in reporting ADHD symptoms. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Objective: To review the pattern of morphological and functional brain changes in both children and adults with ADHD that emerges from the recent literature. In addition, the task of the present review is to explore how to understand the nature of the brain changes. Methods: Literature review. Results: Neuroimaging studies provide a multitude of information that currently allows us to expand the notions of ADHD neurobiology beyond its traditional understanding as a manifestation of frontostriatal dysfunction. They point to disorders of several other areas of the brain, particularly the anterior cingulum, the dorsolateral as well as ventrolateral prefrontal cortex, the orbitofrontal cortex, the superior parietal regions, the caudate nucleus, the thalamus, the amygdala and the cerebellum. Imaging studies point to the persistence of changes in both brain structure and function into adulthood, although there might be a tendency for improvement of caudate nucleus pathology. Changes in neuronal (dendritic) plasticity, which are under the modulatory influence of the dopaminergic system, may be in the background of disorders of brain morphology and anatomical connectivity with subsequent brain dysfunction. Growing evidence suggest that methylphenidate treatment can lead to improvement of brain changes seen in neuroimaging by its positive effect on neuroplasticity. Conclusion: Changes in neuronal plasticity may be behind persisting brain changes in ADHD. Current treatment approaches seem to improve these neuroplastic processes, and, therefore, may have a positive effect on the neuropathology of ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Although there is evidence to suggest an association between ADHD and alcohol use in college students, results are inconclusive primarily because studies have failed to control for related variables. Thus, this study was designed to systematically compare the relative contributions of inattention and hyperactivity/impulsivity to alcohol use and alcohol-related problems in a sample of college students while controlling for effects of antisocial behaviors. Method: A total of 192 undergraduate college students from a rural Midwestern university received class credit for participating in the study. They completed measures of alcohol use, ADHD symptoms, and antisocial behavior. Results: Hierarchical regressions revealed inattention, but not hyperactivity/impulsivity, was related to alcohol-related problems even when controlling for antisocial behavior. However, neither inattention nor hyperactivity/impulsivity was related to alcohol use regardless of whether current antisocial behavior was controlled. Conclusion: Inattention may be an important factor related to alcohol-related problems in college students. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To examine efficacy and safety of adjunctive guanfacine extended release (GXR) on morning and evening ADHD symptoms using the Conners’ Global Index–Parent (CGI-P) and Before-School Functioning Questionnaire (BSFQ). Method: Participants 6 to 17 years with ADHD (N = 461) and suboptimal psychostimulant response were maintained on current psychostimulants and randomized to dose-optimized GXR (≤4 mg/d) in the morning (GXR AM) or evening (GXR PM), or placebo. Results: CGI-P scores improved with GXR (morning assessment, GXR AM, placebo-adjusted least squares [LS] mean = –1.7, GXR PM = –2.6; evening assessment, GXR AM = –2.4, GXR PM = –3.0; all ps < .01). Parent-rated BSFQ scores reflected improved morning functioning with GXR (GXR AM, placebo-adjusted LS mean = –5.1; GXR PM = –4.7; both ps < .01). Most adverse events were mild or moderate. Conclusion: Adjunctive GXR AM or GXR PM was associated with improvements in morning and evening ADHD symptoms in children and adolescents. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Although psychostimulants are commonly utilized to treat preschoolers with ADHD, side effects and parental preferences limit their use in younger children. The current meta-analysis examines the efficacy of parent interventions for the treatment of ADHD in preschoolers. Method: We searched PubMed and the Cochrane Library for randomized, controlled trials comparing behavioral interventions for preschool children with ADHD. Our primary outcome measure was mean improvement in an ADHD rating scale compared with control conditions. Results: Eight trials were included in the final analysis, totaling 399 participants. There was a significant benefit of parental behavioral interventions compared with control conditions (standardized mean difference [SMD] = 0.61, 95% confidence interval = [0.40, 0.83], z = 5.6, p < .001). Conclusion: The present meta-analysis provides preliminary evidence that parental interventions are an efficacious treatment for preschool ADHD. Future research is needed to compare the relative efficacy of parental interventions for ADHD with medication management and to determine if the combination of parental training and medication management is more effective than either condition alone. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study examined neurocognitive and behavioral predictors of math performance in children with and without ADHD. Method: Neurocognitive and behavioral variables were examined as predictors of (a) standardized mathematics achievement scores, (b) productivity on an analog math task, and (c) accuracy on an analog math task. Results: Children with ADHD had lower achievement scores but did not significantly differ from controls on math productivity or accuracy. N-back accuracy and parent-rated attention predicted math achievement. N-back accuracy and observed attention predicted math productivity. Alerting scores on the attentional network task predicted math accuracy. Mediation analyses indicated that n-back accuracy significantly mediated the relationship between diagnostic group and math achievement. Conclusion: Neurocognition, rather than behavior, may account for the deficits in math achievement exhibited by many children with ADHD. (J. of Att. Dis. 2013; XX(X) X-XX)
Objective: Psychological theories have postulated an association between insecure attachment and ADHD. The objective of this study is to investigate possible association between insecure attachment and ADHD in children and adults. Method: Review of literature was performed using the PsycINFO, Medline, and EMBASE databases. Results: Twenty-nine studies were included in the review. Overall, the studies showed that parental attachment problems and environmental mediating factors were significantly associated with childhood ADHD. Adults with ADHD had a much higher incidence of insecure attachment styles than reported in the general population. Conclusion: There seems to be a clear association between ADHD and insecure attachment. It is likely that early intervention in the form of parent training and pharmacological treatment may prevent development of attachment problems. But such studies have not been carried out. Furthermore, adults with ADHD might need treatment for their lack of attachment competences as well. More research on this topic is much needed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The purpose of this essay is to examine peer relationships in youth with ADHD and to review current peer functioning interventions. Method: The studies included in this review were identified using the following search terms: "attention-deficit/hyperactivity disorder," "ADHD," "peer relationships," "friendships," "social skills," "intervention," and "treatment." Other than a few seminal studies published prior to 2000, studies included were published between 2000 and 2012. Results/Discussion: Background information regarding peer relationship difficulties and specific social skills deficits of youth with ADHD is reviewed and current social skills and friendship intervention programs are examined. Future directions also are provided. (J. of Att. Dis. XXXX; XX(X) X-XX)
Objective: The objective of this study was to provide preliminary findings from an ongoing randomized clinical trial using a canine-assisted intervention (CAI) for 24 children with ADHD. Method: Project Positive Assertive Cooperative Kids (P.A.C.K.) was designed to study a 12-week cognitive-behavioral intervention delivered with or without CAI. Children were randomly assigned to group therapy with or without CAI. Parents of children in both groups simultaneously participated in weekly parent group therapy sessions. Results: Across both treatment groups, parents reported improvements in children’s social skills, prosocial behaviors, and problematic behaviors. In both groups, the severity of ADHD symptoms declined during the course of treatment; however, children who received the CAI model exhibited greater reductions in the severity of ADHD symptoms than did children who received cognitive-behavioral therapy without CAI. Conclusion: Results suggest that CAI offers a novel therapeutic strategy that may enhance cognitive-behavioral interventions for children with ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim was to identify subgroups of patients with ADHD with different daily symptom profiles and to characterize their response to modified-release methylphenidate (MR MPH) treatment, using data from the observational trial OBSEER. Method: OBSEER included patients aged 6 to 17 years receiving MR MPH under routine care. To detect subgroups, a latent class cluster analysis was applied. Sex, age, MR MPH dose, and emotional symptoms were considered predictors of response. Results: The analysis included 637 patients (81.3% male), with a mean age (standard deviation) of 10.1 (2.5) years. A two-class solution best fit the data, identifying a high-severity group (49.8%) with pronounced symptom reduction, and a low-severity group (50.2%) with minor changes throughout the day. Younger age, male sex, and higher MPH doses were predictive of the high-severity class. Conclusion: Children with ADHD treated with MR MPH are heterogeneous, and subgroups with differential treatment response can be identified. (J. of Att. Dis. XXXX; XX(X) XX-XX)
Executive functioning (EF) deficits have been associated with ADHD. However, disagreement exists concerning the extent to which cognitive tests of EF accurately reflect a diagnosis of ADHD. Barkley developed the Barkley Deficits in Executive Functioning Scale (BDEFS) by categorizing the meta-construct of EF into five subdomains. Objective: This study investigated the incremental validity of the BDEFS in predicting symptoms of ADHD compared with a visual-search task. We also investigated patterns among the five BDEFS domains. Method: One hundred and sixteen college students completed a visual-search task and the BDEFS and reported on their symptoms of ADHD. Results: (a) BDEFS total scores significantly predicted total ADHD symptoms, whereas the visual-search task failed to predict ADHD symptoms. (b) The BDEFS demonstrated significant correlations with symptoms of ADHD in expected patterns. Conclusion: This study provides evidence of validity for the BDEFS in a college sample. (J. of Att. Dis. 2013; XX(X) 1-XX)
The comorbidity of ADHD and reading difficulties (ADHD + RD) is believed to be a disability distinct from ADHD alone, with unique challenges faced by individuals suffering from one disability versus the other. We aimed to examine the differential effect of 8 weeks of cognitive training on reading abilities and on executive functions, through use of the Wisconsin task, in children with ADHD and in children with ADHD + RD. Greater impairments in reading and executive functions, especially in speed of processing, were found in the comorbid group at baseline. The comorbid group showed greater improvements in most measures after training as well. We propose that the cognitive training used in the present study affected not only the immediate abilities of executive functioning but also the secondary ability of reading, especially in the comorbid group, by improving in particular, speed of processing. We suggest that a differential approach should be taken when treating children with ADHD + RD versus treating ADHD children. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: We sought to develop a brief, easy to use behavior checklist to address common limitations in the use of ADHD rating scales in busy clinical settings. Method: Items for the CHAOS (Conduct-Hyperactive-Attention Problem-Oppositional Symptom) scale were developed based on the ratings of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria provided by experienced clinicians. The scale was administered to mothers of 205 clinically referred children for the purpose of subscale creation based on principal components analysis (PCA). Reliability and validity were analyzed using a separate sample of 139 children referred for psychological testing. Results: PCA resulted in four subscales (Attention Problems, Hyperactivity-Impulsivity, Oppositional Behavior, and Conduct Problems), which demonstrated moderate to high test–retest and interrater reliability. Subscale scores correlated significantly with subscales from a DSM-referenced behavior checklist, along with tests of executive functioning. Conclusion: These data suggest that the CHAOS scale is a brief, psychometrically sound tool for evaluation and monitoring of ADHD symptoms. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim of the present study was to explore factors influencing parents’ decisions to adhere and persist with ADHD pharmacotherapy in children. Method: Focus groups (n = 3) were conducted with 16 parents recruited from metropolitan Sydney. Group discussions explored factors impacting on treatment initiation, continuation, and cessation. Focus groups were audio-recorded, transcribed verbatim, and thematically content analyzed. Results: Parents commenced and continued pharmacotherapy due to its positive impact on their child’s behavior. Improvements in the child’s academic performance and social interactions encouraged persistence with therapy. Parents elected to cease therapy after their children experienced side effects including appetite suppression, weight loss, and sleep disturbances. Concerns about long-term effects of ADHD medication use including potential for addiction and growth stunting, in addition to the stigma surrounding ADHD also contributed to parents ceasing treatment. Conclusion: The findings highlight a need for the provision of accurate information about ADHD and its treatments to parents to empower their treatment decisions and promote adherence. (J. of Att. Dis. 2013; XX(X) XX-XX)
Objective: We investigated the relationship between impulsivity, as measured by delay and probability discounting, and gambling-related cognitions and behavior in adults with and without ADHD. Method: Adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnostic criteria for ADHD (n = 31) and controls (n = 29) were recruited from the community. All completed an interview that included an assessment of psychiatric disorders, gambling questionnaires, and simulated gambling, delay, and probability discounting tasks. Results: The ADHD group was more likely to meet the criteria for problem gambling and was more impulsive than controls based on a composite discounting measure. ADHD symptoms were correlated with gambling-related cognitions and behavior. Probability, but not delay discounting, explained significant variance in gambling-related measures after controlling for ADHD symptoms. Discussion: Results confirm an association between adult ADHD and gambling, and suggest that the facets of impulsivity related to risk proneness may be an independent risk factor for problem gambling in this population. (J. of Att. Dis. XXXX; XX(X) 1-XX)
Objective: This study aimed to test the effect of an irrelevant external distracter included in a computer-administered visual search test. Two hypotheses were tested: (a) If the distracter affects performance, attention efficiency will be lowered; (b) if children do not habituate to the distracter, performance will be lower for every item of the test. Method: Distraction was induced changing the screen color unexpectedly several times in each trial—450 children (225 girls and 225 boys) from second to sixth course were tested. This group was compared with a group of 423 children from the same age range who were tested with the same test without distraction. Results: Induced distraction reduced attention efficiency for all ages and for every trial in the treatment group (test with distraction). Speed was lower, but number of errors did not increase. Conclusion: School-age children cope with an irrelevant external distracter by reducing speed, not accuracy. (J. of Att. Dis. 2013; XX(X) X-XX)
Objective: In preclinical studies, lobeline inhibited hyperactivity induced by nicotine and amphetamine, and improved performance and learning in studies utilizing radial-arm maze and spatial-discrimination water maze. This laboratory proof-of-concept study investigated lobeline as a treatment for ADHD symptoms in adults (31.11 ± 7.08 years). Method: Using cognitive tasks and self-report measures, the effects of lobeline (0, 7.5, 15, or 30 mg, s.l.) and methylphenidate (0, 15, or 30 mg, p.o.) were assessed in nine volunteers with ADHD. Results: Evidence suggested that lobeline could modestly improve working memory in adults with ADHD, but no significant improvement in attention was observed. Lobeline administration was associated with mild adverse side effects (nausea). Conclusion: Further investigation of lobeline on working memory may be warranted.
Objective: Little is known about cognition in preschoolers with ADHD and language delay (LD). The objective was to investigate cognitive functions in preschoolers with ADHD symptoms and LD compared with children with ADHD symptoms only and to estimate the frequency of children with ADHD symptoms, co-occurring language delay, and delays on cognitive measures. Method: Participants were recruited from the Norwegian Mother and Child Cohort Study. The teacher report of expressive language and the cognitive tests from 119 3-year-old children with parent reported ADHD symptoms and LD were compared with those of 258 children with ADHD symptoms only. Results: The ADHD + LD group performed significantly worse than the ADHD group on most language-related measures. There were no differences between the groups on most nonverbal measures. Single measures had a limited potential of differentiating between the groups. Conclusion: ADHD symptoms and co-occurring LD in preschoolers were characterized by cognitive deficits associated with both disorders, not with global neurodevelopmental delay. (J. of Att. Dis. 2013; XX(X) 1-XX)
Background: ADHD involves impairing core symptoms of inattention and hyperactivity/impulsivity in children (childhood ADHD = CH) that may persist in adulthood (adult ADHD = AD). Conflicting findings have been found regarding AD prevalences among adult smokers, and it is unclear whether AD is associated with a more severe smoking behavior in adulthood. Objective: The aim of this article is (a) to determine CH and AD prevalences in a nonselected sample of adult smokers, (b) to describe the characteristics of smokers with ADHD symptoms versus those without, and (c) to determine whether CH and/or AD symptoms are risk factors for more severe smoking in adulthood. Method: Three hundred and seventy-three participants aged 18 years and over were prospectively recruited in a smoking-cessation unit. Participants were classified as "no ADHD symptoms," "CH symptoms," or "AD symptoms" according to their baseline score on the Wender Utah Rating Scale (WURS) alone (for CH symptoms) and WURS combined to the Adult Self Report Scale (ASRS) for AD symptoms. Other clinical variables were reported at first consultation. Results: (a) CH symptoms were reported in 15.3% (57/373) of the total sample, 42.1% (24/57) of whom also had persistent ADHD symptoms in adulthood (prevalence of AD was 24/373 = 6.4%). (b) In comparison with participants without ADHD symptoms, smokers with ADHD symptoms consume significantly more tobacco, but ADHD symptoms were no longer significantly associated with the daily number of smoked cigarettes after adjustment for sociodemographic variables. No significant association was found between the two groups and age at the first cigarette, age at onset daily smoking, and nicotine dependence. (c) Participants were categorized into three groups: Group 1 without ADHD symptoms lifetime (NH; n = 316), Group 2 with childhood history of ADHD symptoms (CH; n = 33), and Group 3 with Adult ADHD symptoms (AD; n = 24). The association with tobacco consumption (>20 cigarettes/day) was significant for CH only (p = .02). After adjustment for gender, age, professional status, and educational level, this association was not longer significant. Conclusion: Childhood and adult ADHD symptoms are both highly prevalent among nonselected smokers but our study failed to show more severe smoking characteristics among these participants after adjustment with sociodemographic variables. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: ADHD is associated with social and emotional impairment that goes beyond the core symptoms of hyperactivity, impulsivity, and attention deficits. This study evaluates the comparative efficacy of emotional management training (EMT) with social skills training (SST) and no treatment in children with ADHD. Method: A randomized, controlled treatment outcome study was conducted with 32 boys and 40 girls (aged 10-12 years). The Child Behavior Checklist, Emotion Expression Scale for Children, Child Depression Inventory, and State-Trait Anxiety Inventory for children were completed before and after the intervention. Results: The EMT group exhibited a significant improvement in emotion recognition and expressive reluctance. Therefore, focusing on emotion identification and expression in social cognitive processes (i.e., EMT), instead of merely focusing on social skills (SST), enhances treatment efficacy. Conclusion: These results support the hypothesis that focusing on the identification and expression of emotional information processes, instead of merely focusing on social skills (SST) enhances treatment efficacy. (J. of Att. Dis. 2012; XX(X) 1-XX)
Objective: The aim of the study was to investigate motor performance in children with ADHD using a size-scaling handwriting task. Method: In all, 14 male children with ADHD and 14 typically developing (TD) children (age 7-15) wrote 10-mm and 40-mm cursive letter "l." Results: Children with ADHD were unable to maintain their writing accurately at 40 mm, falling short by several millimeters; this was not evident in the TD children. Children with ADHD also had slightly faster and more fluent writing than TD children. Conclusion: It was concluded that children with ADHD have difficulties scaling handwriting movement in the larger 40-mm condition that may reflect poor planning and modulation of movement, despite having faster and more fluent movements.(J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To examine nonmedical use (NMU) of prescription ADHD stimulants among adults evaluated for substance abuse treatment. Method: 147,816 assessments from the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) system (10/01/2009 through 03/31/2012) examined NMU prevalence, routes of administration (ROA), and diversion sources. Results: Past 30-day NMU for prescription stimulants (1.29%) was significantly lower than that of prescription opioids (19.79%) or sedatives (10.62%). For stimulant products, NMU for Adderall was 0.62, followed by Adderall XR (0.42), Ritalin (0.16), Vyvanse (0.12), and Concerta (0.08); product differences likely have limited clinical relevance given the low estimates (<1%). Higher NMU per prescriptions was for Adderall (4.92), Ritalin (4.68), and Adderall XR (3.18) compared with newer formulations (Vyvanse 1.26, Concerta 0.89). Diversion source was mainly family/friends with no differences between products; swallowing whole was the most frequent ROA. Conclusion: Prescription stimulant NMU was low compared with other prescription medications among individuals assessed for substance abuse problems, with little difference among specific products. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The relationship between working memory (WM) and objectively measured motor activity was examined in adults with ADHD and healthy controls (HCs). Method: Thirty-five adults (ADHD = 20, HC = 15) were grouped using self-report and collateral-report measures in addition to a semistructured clinical interview. All participants completed control conditions with minimal WM demands, and separate phonological (PH) and visuospatial (VS) WM tasks with recall demands ranging from four to seven stimuli. Results: The ADHD group exhibited significantly more motor activity relative to the HC group, and both groups exhibited greater activity during PH and VS WM tasks, relative to control conditions. Finally, the central executive (CE) and PH storage/rehearsal subsystems were associated with large-magnitude between-group differences in activity. Conclusion: Findings suggest that increased demands on WM, particularly the CE and PH storage/rehearsal, contribute to ADHD-related hyperactivity, though a portion of excessive motor activity in adults with ADHD may occur independently of WM demands. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Children with sleep disorders tend to experience attention problems, yet little is known about the relationship between sleep and attention in early development. This prospective follow-up study investigated the longitudinal relationships between neonatal sleep, attention, and distraction in infants born preterm. Method: We used actigraphy and sleep-wake diaries in the neonatal intensive care unit (NICU, N = 65), attention orienting in a visual-recognition-memory task (VRM) at age 4 months, and structured observation of attention and distractibility at age 18 months. Results: Infants with poorer neonatal sleep (n = 31) exhibited longer first gaze durations in the VRM at 4 months and longer distraction episodes at 18 months relative to neonatal controls who slept well (p < .01). Hierarchical regression models support relations between neonatal sleep and gaze behavior at 4 months and distractibility at 18 months; moreover, alterations in orienting attention at 4 months predicted the likelihood of being distracted during the second year of life. Conclusions: Findings underscore the importance of early sleep-wake and attention regulation in the development of distraction in infants born preterm.
Objective: An ecologically valid adaptation of the irrelevant sound effect paradigm was employed to examine the relative roles of short-term memory, selective attention, and sustained attention in ADHD. Method: In all, 32 adults with ADHD and 32 control participants completed a serial recall task in silence or while ignoring irrelevant background sound. Results: Serial recall performance in adults with ADHD was reduced relative to controls in both conditions. The degree of interference due to irrelevant sound was greater for adults with ADHD. Furthermore, a positive correlation was observed between task performance under conditions of irrelevant sound and the extent of attentional problems reported by patients on a clinical symptom scale. Conclusion: The results demonstrate that adults with ADHD exhibit impaired short-term memory and a low resistance to distraction; however, their capacity for sustained attention is preserved as the impact of irrelevant sound diminished over the course of the task. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Despite the availability of several effective treatments, many children with ADHD do not receive adequate services. A variety of factors may influence help-seeking behavior among families of children with ADHD. This study explores two factors that may influence help-seeking decisions: knowledge and misconceptions of ADHD and treatment acceptability. Method: A total of 196 participants completed measures of ADHD knowledge and use of information sources prior to rating the acceptability of two interventions: stimulant medication and sugar elimination diets. Results: Higher levels of ADHD misconceptions were associated with lower acceptance of medication and higher acceptance of dietary interventions. However, analysis of individual misconceptions suggests that specific misconceptions are differentially related to perceptions of individual treatments. Conclusion: It may be important for clinicians to assess and deliberately target specific misconceptions as part of treatment for ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Although a number of studies demonstrate that children with ADHD do not attribute their behavior to taking medication, it remains unstudied whether adolescents, who have a longer history of taking medication for ADHD, show performance attributions to medication. Method: A sample of 46 adolescents completed daily attributions for success or failure as a part of their participation in a summer treatment program with a double-blind, placebo-controlled assessment of methylphenidate. Results: Results demonstrated that adolescents with ADHD did not reliably discern active medication from placebo, rarely attributed their performance to the pill, and showed no differences in attributional style as a function of medication status. Conclusion: These data indicate that adolescents with ADHD may possess inaccurate beliefs about the effect of stimulant medication on their behavior. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To examine the role of physical activity in determining the affect and executive functioning of children with symptoms of ADHD. Method: In Study 1, the association between physical activity and affect in the daily lives of children with varying degrees of hyperactivity was examined. In Study 2, children with ADHD were randomly assigned a physical activity or a sedentary task before working on a task requiring executive control. Results: Lack of physical activity was shown to relate to depressed affect, more strongly in participants with severe hyperactivity symptoms (Study 1). The physically active participants showed improved executive functioning after only 5 min of vigorous activity; the sedentary control participants showed no improvement (Study 2). Conclusion: These results indicate that interventions to increase the level of physical activity in children with and without ADHD might improve affect and executive functioning. (J. of Att. Dis. 2013, XX(X)1-XX)
Objective: The aim of this study was to examine the role of emotional distress as well as ADHD symptomatology in explaining (a) recidivism, (b) behavioral disturbances in prison, and (c) violent and nonviolent offending. Method: In all, 196 male prisoners from Aberdeen prison completed the Symptom Checklist–90, which examines various clinical symptoms and emotional distress. Current adult symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. Results: Emotional distress and ADHD explained the variance in prison records of behavioral disturbance above and beyond antisocial personality (ASP) traits; however, much of the effect of emotional distress was mediated by ADHD symptoms. Only ADHD symptoms were significantly associated to history of violent offending, whereas ASP and age mostly explained nonviolent offenses and overall recidivism. Conclusion: Our results provide support for the conceptual association between ADHD and its related emotional dimension with behavioral disturbance in prison, suggesting a link to reactive violence. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The objective was to evaluate whether Conners 3 (Conners 3rd edition) ratings of ADHD symptoms are robust to distortion by cultural variation when applied to children with migration background living in Germany. Method: From 2010 to 2011, Conners 3 data (self-rating, parent rating, and teacher rating) of 243 children with Turkish migration background, aged 6 to 16 years, were collected in various German schools. Allocation of items to latent factors was tested with confirmatory analyses. Reliability and validity of resulting factors was calculated and influence of acculturation, gender, and age on rating-modalities was examined. Results: Confirmatory factor analyses showed high model fits for all rating-modalities. Resulting scales had good reliability and validity. There was a small influence of acculturation on parent ratings of oppositional defiant disorder but not on ADHD core symptoms. Conclusion: Conners 3 ratings seem to be robust against influences of cultural variation. Their German translation can be utilized for children with Turkish migration background without limitation. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim of this study was to observe whether the independent presence of Sluggish Cognitive Tempo (SCT) directly impacts on the Executive Function (EF), and to determine whether there are deficits in EF that are unique to ADHD predominantly inattentive (ADHD-I) or SCT. Method: Seventy-six participants aged 6 to 17 years and their parents were assessed using a diagnostic interview, an instrument that assesses the EF, and another instrument that assesses the SCT. Two hierarchical linear regression models were performed. The first one analyzed the independent relationship between SCT and EF, and the second model added the symptomatology of ADHD-I. Results: The SCT has a statistically significant direct relation on the EF deficits and remains in the second model even with the inclusion of the ADHD-I. Conclusion: The SCT and ADHD-I symptoms independently promote executive deficits. Children with ADHD-I symptoms showed deficits in most areas of the EF. Deficits in inhibition and initiative are unique to inattention. (J. of Att. Dis. 2011; XX(X) 1-XX)
Objective: The present study investigated the validity of using the Conners’ Teacher and Parent Rating Scales (CTRS/CPRS) or semistructured diagnostic interviews (Parent Interview for Child Symptoms and Teacher Telephone Interview) to predict a best-practices clinical diagnosis of ADHD. Method: A total of 279 children received a clinical diagnosis based on a best-practices comprehensive assessment (including diagnostic parent and teacher interviews, collection of historical information, rating scales, classroom observations, and a psychoeducational assessment) at a specialty ADHD Clinic in Truro, Nova Scotia, Canada. Sensitivity and specificity with clinical diagnosis were determined for the ratings scales and diagnostic interviews. Results: Sensitivity and specificity values were high for the diagnostic interviews (91.8% and 70.7%, respectively). However, while sensitivity of the CTRS/CPRS was relatively high (83.5%), specificity was poor (35.7%). Conclusion: The low specificity of the CPRS/CTRS is not sufficient to be used alone to diagnose ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: ADHD is frequently detected in boys though there is no established cause. One possibility is that genes predisposing to ADHD have sexually dimorphic effects. With an aim to find out the reason for this male biasness, contribution of 14 functional polymorphisms was investigated in ADHD subjects. Method: Genomic DNA of probands, their parents, and ethnically matched controls was subjected to analysis of single-nucleotide polymorphisms and variable number of tandem repeats (VNTRs). Results: Case–control analysis revealed significant higher occurrence of DAT1 intron 8 VNTR "5R" allele (p = .028), DBH rs1108580 "A" allele (p = .027), and MAOA-u VNTR-rs6323 3R-T haplotype (p = .007) in male probands. Family-based analysis showed significant preferential transmission of Dopamine receptor D4 exon 3 VNTR-rs1800955 7R-T haplotype from parents to male probands (p = .008). Interaction between DBH gene variants and low enzymatic activity was also noticed, especially in male probands. Conclusion: Data obtained may partly answer the male biasness of ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The purpose of this study was to examine the effects of preresponse cues on behavioral control in adults with ADHD. Method: Eighty-eight adults with ADHD and 67 adults with no history of ADHD completed a cued go/no-go task. This task requires participants to respond or inhibit a response to go and no-go targets, respectively, and preresponse cues provide participants with predictive information about the upcoming target. Results: Overall, participants with ADHD made more inhibitory failures and responded more slowly than controls. These group differences were only present in the valid-cue condition, and there were no significant group differences in the invalid-cue conditions. Conclusion: These findings suggest that adults with ADHD are less able to utilize predictive environmental information to facilitate behavioral control. (J. of Att. Dis. 2013; XX(X) 1-XX)
Children with ADHD have been widely reported to overestimate their abilities in social and academic domains, but a similar overestimation of physical abilities has not been examined. Twenty-four elementary school-age boys with ADHD and fifteen boys without ADHD were compared on their ability to accurately estimate their ability to complete four lab-based physical tasks, varying on three levels of difficulty: (a) within their ability, (b) 8% beyond their ability, and (c) 13% beyond their ability. Children with ADHD were significantly more likely than controls to overestimate their physical ability at difficult levels of the task. Implications of these results for preventing risky behaviors in children with ADHD are discussed.
Objective: This study aimed to determine whether the Strengths and Difficulties Questionnaire (SDQ) is an effective screening tool for identifying comorbid mental health difficulties in children with ADHD. Method: Parents of children with ADHD (5-13 years) completed the SDQ and the Anxiety Disorders Interview Schedule for DSM-IV–Parent Version (ADIS-C/P-IV). Data from both the measures were compared to determine congruent validity. Results: Analyses revealed that significant relationships exist between the SDQ total score and the total number of comorbidities on the ADIS-C/P-IV. The SDQ emotional problem and conduct problem scales were significantly related to internalizing and externalizing comorbidities on the ADIS-C/P-IV, respectively. Conclusion: While significant relationships were found between the SDQ and ADIS-C/P-IV across various domains, this relationship was stronger for externalizing comorbidities. Additional screening questions are required to effectively screen for less common internalizing comorbidities in children with ADHD, for example, major depression and panic disorder.
Objective: Children with ADHD often demonstrate poor emotional self-awareness and higher levels of externalizing behavior problems relative to unaffected children. This study examined the relation of deficient emotional self-awareness to externalizing behavior problems in children with ADHD, and the role of emotional reactivity in this relationship. Method: Fifty-one 8- to 12-year-old children with ADHD and their parents completed measures of the children’s emotional and behavioral functioning, as well as a diagnostic structured interview. Results: Logistic regression suggested that more impaired emotional self-awareness was strongly associated with the diagnosis of a comorbid externalizing disorder. Hierarchical regression analyses strongly supported the relation of poor emotional awareness to reactivity-driven externalizing behavior, but not to proactive externalizing behavior. These effects were evident across reporters. Conclusion: This study suggested that poor emotional self-awareness is significantly linked to externalizing problems in children with ADHD, and that dysregulated emotional reactivity plays an important role in this relationship. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To examine the health care costs associated with ADHD within a nationally representative sample of children. Method: Data were from Waves 1 to 3 (4-9 years) of the Longitudinal Study of Australian Children (N = 4,983). ADHD was defined by previous diagnosis and a measure of ADHD symptoms (Strengths and Difficulties Questionnaire [SDQ]). Participant data were linked to administrative data on health care costs. Analyses controlled for demographic factors and internalizing and externalizing comorbidities. Results: Costs associated with health care attendances and medications were higher for children with parent-reported ADHD at each age. Cost differences were highest at 8 to 9 years for both health care attendances and medications. Persistent symptoms were associated with higher costs (p < .001). Excess population health care costs amounted to Aus$25 to Aus$30 million over 6 years, from 4 to 9 years of age. Conclusion: ADHD is associated with significant health care costs from early in life. Understanding the costs associated with ADHD is an important first step in helping to plan for service-system changes. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study aimed to examine the accuracy of self-reports of children and adolescents with ADHD in evaluating activity limitations. Method: Self-reports of children/adolescents with ADHD (n = 89) were compared with those of nonreferred children (n = 94), relative to parent reports about children’s competence. Competence was measured with a 34-item rating scale. Behavioral disorders were documented with the Child Behavior Checklist. Results: Children/adolescents with ADHD were much more likely than controls to overestimate their competence in certain daily activities relative to parent reports, demonstrating a positive illusory bias. Positive illusory bias was found to be pronounced in activities, which were expected to be affected by symptoms of ADHD. Overestimations of competencies were more likely to be accompanied with externalizing problems. Conclusion: Results support the presence of the positive illusory bias also in the domain of everyday life activities. Improvement of self-evaluation of competencies should become a focus of treatment. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: When behavioral problems resulting from attentional difficulties present, often in preschool, it is unknown whether these problems represent preexisting altered brain development or new brain changes. This study examines whether infant sensory gating of auditory evoked potentials predicts parent-reported behavior at 40 months. Method: P50 sensory gating, an auditory evoked potential measure reflective of inhibitory processes in the brain, was measured in 50 infants around 70 days old. Parents, using the Child Behavior Checklist, reported on the child’s behavior at 40 months. Results: Controlling for gender, infants with diminished sensory gating had more problems later with externalizing behavior (F = 4.17, ndf = 1, ddf = 46, p = .047), attentional problems (F = 5.23, ndf = 1, ddf = 46, p = .027), and anxious/depressed symptoms (F = 5.36, ndf = 1, ddf = 46, p = .025). Conclusion: Diminished infant P50 sensory gating predicts attention symptoms 3 years later. These results support the hypothesis that preschool attentional dysfunction may relate to altered brain development that is detectable years prior to symptom onset. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The Das–Naglieri Cognitive Assessment System (CAS) is a test of cognitive abilities based on the Planning, Attention, Simultaneous, and Successive Theory (PASS). Studies of CAS performance by children with ADHD typically show lowest performance on Planning and deficits on Attention, but normal Simultaneous and Successive processing. Such distinct group differences studies support construct validity and are necessary, but not sufficient, for establishing diagnostic utility. Method: Students meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for ADHD (n = 20) and matched controls (n = 20) were assessed with the CAS to examine distinct group differences and diagnostic utility of CAS in correctly classifying the individuals from both groups. Results: CAS PASS scores were significantly related to ADHD characteristics demonstrating both distinct group differences (with medium to large effect sizes) and diagnostic utility (with medium effect sizes). Conclusion: Support was observed for CAS PASS score characteristics previously observed among students with ADHD, and this is the first study to report on the diagnostic utility of CAS PASS scores. Given the small sample, additional large-scale studies and cross-validation is needed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objectives: ADHD and reading disability (RD) are distinct disorders that often appear together. Individuals with both disorders are currently diagnosed based on questionnaires/behavioral performance. The present study aimed to determine whether ADHD alone differs from ADHD with RD in error monitoring, which is part of the executive system, as measured while reading. Method: Event-related potentials were recorded during a lexical decision task performed by children with comorbid ADHD and RD and children with ADHD. Results: Lower executive function and reading abilities were accompanied by decreased event-related potential components in participants with ADHD and RD, compared with participants with ADHD. Conclusion: Results suggest that the error monitoring activation can be used as a possible biomarker to objectively differentiate ADHD with RD from ADHD alone. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Recent publications reported that a bifactor model better represented the underlying structure of ADHD than classical models, at least in youth. The Adult ADHD Symptoms Rating Scale (ASRS) has been translated into many languages, but a single study compared its structure in adults across Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (ICD-10) classifications. Method: We investigated the factor structure, reliability, and measurement invariance of the ASRS among a community sample of 1,171 adults. Results: Results support a bifactor model, including one general ADHD factor and three specific Inattention, Hyperactivity, and Impulsivity factors corresponding to ICD-10, albeit the Impulsivity specific factor was weakly defined. Results also support the complete measurement invariance of this model across gender and age groups, and that men have higher scores than women on the ADHD G-factor but lower scores on all three S-factors. Conclusion: Results suggest that a total ASRS-ADHD score is meaningful, reliable, and valid in adults. (J. of Att. Dis. 2013; XX(X) 1-XX
Objective: Individuals with ADHD face significant neurodevelopmental hurdles with inattention and/or hyperactive/impulsive behavior through their life span. Mindfulness training may be one self-regulatory method for strengthening attentional processes (orienting, alerting, and executive attention). This review’s goals are to (a) argue for the use of mindfulness training as an adjunct to evidence-based treatment for ADHD and (b) call for improving psychosocial intervention for ADHD within families by integrating mindfulness training with behavioral parent training. Method: EBSCOhost was utilized to search 29 psychology-related research databases through Athabasca University. Results: Mindfulness training should be incorporated into current treatment guidelines as a psychosocial option for families with ADHD. Conclusion: Preliminary findings suggest significant improvements in attentional processes, and prominent mindfulness-based approaches have been successfully adapted for ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To compare the long-term self-esteem and social function outcomes of individuals with untreated and treated ADHD across childhood, adolescence, and adulthood. Method: A systematic search of 12 databases was performed to identify peer-reviewed, primary research articles, published January 1980 to December 2011, reporting long-term self-esteem and/or social function outcomes (≥2 years; life consequences distinct from symptoms) of individuals with untreated or treated ADHD. Results: Overall, 127 studies reported 150 outcomes. Most outcomes were poorer in individuals with untreated ADHD versus non-ADHD controls (57% [13/23] for self-esteem; 73% [52/71] for social function). A beneficial response to treatment (pharmacological, nonpharmacological, and multimodal treatments) was reported for the majority of self-esteem (89% [8/9]) and social function (77% [17/22]) outcomes. Conclusion: Untreated ADHD was associated with poorer long-term self-esteem and social function outcomes compared with non-ADHD controls. Treatment for ADHD was associated with improvement in outcomes; however, further long-term outcome studies are needed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Using a 4-year longitudinal design, we evaluated two hypotheses based on developmental executive function (EF) hierarchy accounts in a sample of children with externalizing problems. Method: The participants performed EF tasks when they were between 8 and 12 years (M = 9.93), and again approximately 4 years later when they were between 12 and 15 years (M = 13.36). Results: Inhibition in middle childhood predicted working memory (WM) 4 years later. Further, deficits in inhibition and sustained attention were more prominent in middle rather than late childhood, whereas poor WM was salient throughout these periods. Conclusions: These findings support the hypotheses that EFs develop hierarchically and that EF deficits in ADHD are more prominent in actively developing EFs. They also emphasize ADHD as a developmental disorder. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The aim of this study was to (a) test the usefulness of visuospatial working memory (VSWM) as an endophenotype for ADHD and (b) study the developmental trajectory of VSWM in ADHD. Method: A total of 110 ADHD patients, 60 unaffected siblings (US), and 109 healthy controls (HC), aged 8 to 29 years, were assessed on VSWM functioning. Multilevel analyses were carried out to account for the correlation between measurements within families. Results: ADHD patients showed impaired VSWM performance compared with unaffected siblings and HC, with comparable performance between unaffected siblings and HC. Impaired VSWM in ADHD patients was not more pronounced on higher memory loads, signifying executive rather than storage deficits as an underlying mechanism. ADHD patients, unaffected siblings, and HC showed parallel developmental trajectories of VSWM. Conclusion: Current findings question the usefulness of VSWM as a neurocognitive endophenotype for ADHD and provide unique insights into the developmental trajectory of VSWM in ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: We examined the risk of hospital-treated injuries related to the symptoms/diagnosis of ADHD. Method: The study population (N = 6,111) was composed from the Northern Finland Birth Cohort 1986. At the age of 8, symptoms of hyperactivity and at the age of 15, symptoms of ADHD were assessed by the parents while the clinical diagnoses of ADHD were set in adolescence. Information on injuries was obtained from national register. Results: The risk for hospital-treated injuries during ages 0 to 7 was 1.7-fold increased among those with symptoms of hyperactivity assessed at age 8. Also, injuries during ages 7 to 15 years were more common among those with symptoms of ADHD at age 15 with respect to any injury, fractures, and intracranial injuries, and among those with the diagnosis of ADHD with respect to any injury. Conclusion: The present study shows an association between hospital-treated injuries and symptoms of ADHD in a large epidemiological sample of 0- to 15-year-old children. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objectives: (a) Evaluate the efficacy and duration of effect of lisdexamfetamine dimesylate (LDX) in adult ADHD. (b) Assess the reliability and validity of the Adult ADHD Medication Smoothness of Effect Scale (AMSES) and Adult ADHD Medication Rebound Scale (AMRS). Method: Adults (N = 40) with ADHD were treated with LDX for up to 12 weeks. The primary efficacy measure was the ADHD Rating Scale (ADHD-RS). The psychometric properties of the AMSES and AMRS are analyzed and compared with the ADHD-RS, ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklist, and Time-Sensitive ADHD Symptom Scale (TASS). Results: ADHD-RS scores were significantly improved with LDX. The AMSES and AMRS had high internal consistency and were correlated with the ADHD-RS, ASRS v1.1 Symptom Checklist, and TASS. Conclusion: LDX is effective in treating adult ADHD and has a smooth drug effect throughout the day with limited symptom rebound. The AMSES and AMRS are valid and reliable measures. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: ADHD and Hyperkinetic Disorder (HKD) have the same 18 symptoms, covering inattention (IA), hyperactivity (HYP), and impulsivity (IMP). This study was aimed at providing descriptive scores for the different symptom groups in these disorders and how these scores varied by age and gender, the percentages of individuals meeting the symptom thresholds for the different ADHD types and HKD, the factor structure, and gender invariance of these symptoms in adults. Method: To accomplish this, 852 adults provided self-ratings for a scale comprising the 18 ADHD/HKD symptoms. Results: The findings showed that age and gender had minimal effects on the ADHD symptoms. Also, in terms of symptom counts, 2% had HKD and 6.3% had ADHD (inattentive = 1.6%, hyperactive-impulsive = 2.7%, and combined type = 2.0%). Confirmatory factor analysis (CFA) provided most support for the three-factor HKD model, involving separate factors for the IA, HYP, and IMP symptoms. This model showed full measurement invariance across gender. Conclusion: The theoretical and clinical implications of the findings are discussed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: As an exploratory study, this article investigated the relationship between ADHD symptoms and the style of language use of undergraduate college students in Korea. Method: For this study, participants were asked to use stream-of-consciousness writing about any topic. Then, each participant’s piece of writing was analyzed by the Korean Linguistic Inquiry and Word Count (KLIWC), a language analysis program. Results: The findings in this study demonstrated that college students with ADHD symptoms used significantly less "clauses per sentence," "morphemes per sentence," "numeral pronouns," "English," and "home," whereas they used significantly more "sentences," "adjectives," and "TV and movie" in their consciousness writing. Conclusion: This study indicates that college students with ADHD traits have a different language style from their non-ADHD cohorts. Further research studies should be conducted to replicate our findings and develop specific interventions accordingly. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To determine whether the frequency and duration of the periods of suppression of a percept in a binocular rivalry (BR) task can be used to distinguish between participants with ADHD and controls. Method: A total of 122 participants (6-15 years) were assigned to three groups: ADHD-Combined (ADHD-C), ADHD-Predominantly Inattentive (ADHD-I), and controls. They each performed a BR task and two measures were recorded: alternation rate and duration of exclusive dominance periods. Results: ADHD-C group presented fewer alternations and showed greater variability than did the control group; results for the ADHD-I group being intermediate between the two. The duration of dominance periods showed a differential profile: In control group, it remained stable over time, whereas in the clinical groups, it decreased logarithmically as the task progressed. Conclusion: The differences between groups in relation to the BR indicators can be attributed to the activity of involuntary inhibition. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study examined the feasibility and effectiveness of a behavioral parent training (BPT) group intervention implemented in an outpatient mental health setting in reducing child impairments and increasing parenting confidence in managing child behavior. Method: Parents of 241 children with ADHD participated in the eight-session parent group program, completing the Impairment Rating Scale (IRS) and a measure of parenting confidence at the first and last session. Results: Parents reported improvements in child behavior across all domains of the IRS, with the largest improvements in terms of overall impairment, parent–child relationship, and impact of child behavior on the family. Parents also reported increased confidence in managing their child’s behavior. Conclusion: These findings suggest that brief BPT group programs administered to a diverse range of attendees in a typical outpatient setting result in improvements in functional impairments comparable with those produced in controlled studies, as well as improved parenting confidence. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The number of students with a disability requesting test accommodations has been steadily increasing in higher education settings. The present study examined the effects of extra time on the reading comprehension performance of college students with and without ADHD. Method: A modified version of The Nelson–Denny Reading Test was completed by 38 college students with ADHD and 38 matched controls under three conditions: standard time, time and one half, and double time. Results: Groups did not differ in the number of items attempted or correctly answered at standard time, time and one half, or double time. Comparing the ADHD group at extended time to non-ADHD peers at standard time, the ADHD group attempted and answered significantly more test items. Conclusion: Extra time conferred an advantage to the ADHD group, suggesting that extended time accommodations are not specific and perhaps not necessary for all college students with an ADHD diagnosis. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The psychometric properties of the Motor Behavior Checklist (MBC) were examined. Method: A normative database of primary students (N = 841), rated by their physical educators in school settings, were used to investigate the construct validity of the MBC, the internal consistency, the reproducibility, and the interrater agreement. Results: Psychometric results supported the model. Confirmatory factor analyses revealed a second-order model with two (Externalizing and Internalizing) broadband domains and seven problems scales: Lack of Attention (10 items), Hyperactivity/Impulsivity (14 items), Rules Breaking (7 items), Low Energy (4 items), Stereotyped Behaviors (2 items), Lack of Social Interaction (10 items), and Lack of Self-Regulation (12 items). Conclusion: Although MBC for children is not a diagnostic tool itself, it can provide valid complementary information on attentional, emotional, and developmental problems in children when used by physical educators in school settings. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study examined the retrospective history of childhood ADHD symptomatology in an adult narcoleptic population (Narcolepsy Group [NG]: n = 161) compared with a control group (CG: n = 117). Method: Both groups completed the Wender Utah Rating Scale (WURS), a retrospective self-report questionnaire indicating the presence of childhood ADHD symptomatology in adults. Results: Childhood ADHD symptoms were significantly greater in NG than CG (p < .001). Joint prevalence calculations of childhood ADHD symptomatology in NG were more than 8 to 15 times greater than expected. Among NG, those individuals with a greater score on the WURS, indicative of childhood ADHD symptomatology, also had shorter sleep onsets on the Multiple Sleep Latency Test, a common objective measure of sleepiness, t(97) = –7.11, p < .05. Conclusion: It appears that self-reported childhood ADHD symptomatology history among adult narcoleptics is common. Future research is warranted with adult narcoleptics to elucidate the true nature of this. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Social cognitive functions in adults with ADHD were investigated in a virtual social exchange game. Method: The sample consisted of 40 participants (20 adult ADHD participants, 20 healthy controls). Participants played a multiround trust game with virtual trustees who differed in regard to fairness and presence of emotional facial cues. Results: Investments were higher in ADHD participants than in healthy participants except for partners who played fair with constant neutral expressions. ADHD patients did not adapt their behavior to the fairness of the trustee. In the presence of emotional facial cues, ADHD and healthy participants transferred more monetary units to happy rather than angry-looking trustees. Differences in investment behavior were not linked to deficits in emotion-recognition abilities or cognitive dysfunctions. Conclusion: Alterations in interaction behavior and in the formation of a general attitude toward social partners could be shown in adults with ADHD. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: Studies have identified an exacerbation of ADHD deficits under specific laboratory conditions. Less is known about the significance of such contextual factors in relation to everyday functioning in naturalistic settings. Method: This study investigated the differential impact of classroom "idle time"—periods when students are not actively engaged or waiting for a task—on the behavior of 31 children with ADHD (25 boys and 6 girls; aged 6-12 years) and 31 sex- and age-matched typically developing classmates, who were simultaneously observed in their normal classroom during two school days. Results: Both groups experienced the same amount of idle time (12% of the time). During idle time, however, levels of hyperactivity and noisiness increased significantly more in children with ADHD than in their classmates (p < .05). Conclusion: Findings highlight the differential susceptibility of ADHD children to classroom idle time. Classroom interventions might consider targeting specifically these periods to reduce disruptive behavior in these children. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: This study examined the bifactor models of ADHD in three groups: adolescents from the general community (n = 214), adults from the general community (n = 366), and a clinic sample (n = 245). Method: For the adolescent sample, mothers provided ratings of the ADHD symptoms, and their teachers provided ratings for Emotional Symptoms, Conduct Problems, Hyperactivity, Peer Problems, and Prosocial Behavior. For the adult sample, all adults completed self-ratings of the ADHD symptoms and measures for depression, anxiety, and stress. For the clinic-referred sample, mothers provided ratings of the ADHD symptoms, and they were diagnosed for ADHD, Conduct Disorder/Oppositional Defiant Disorder, anxiety disorders, and depression disorders. Results: The findings for all samples supported the bifactor model, and there were differences in the way the general and specific factors correlated with the external variables. Conclusion: The findings support the validity of the bifactor model. (J. of Att. Dis. 2013; XX(X) 1-XX)
This study explored the nature of interactions between adolescent males with ADHD and their mothers, and the effects of methylphenidate (MPH) on an analogue parent–teen interaction task. Twenty-five adolescent males with ADHD (M = 13.6 years) and their mothers and 14 non-ADHD adolescent males (M = 13.4 years) and their mothers completed ratings of perceived dyadic conflict. Behavioral observations of dyads during 10-min conflict-resolution tasks were also collected. The ADHD dyads completed these tasks twice, with adolescents receiving either 0.3 mg/kg MPH or placebo. Videotaped sessions were coded using the Parent–Adolescent Interaction Rating Scale. Following the conflict-resolution task, participants rated their perceived conflict and affect during the interaction. Findings indicated higher conflict in the ADHD dyads, and minimal MPH effects on parent–teen interactions during the analogue task. Results suggest that stimulant medication does not produce meaningful acute effects on parent–teen interactions. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The preference for sooner smaller over larger later rewards is a prominent manifestation of impulsivity in ADHD. According to the State Regulation Deficit (SRD) model, this impulsive choice is the result of impaired regulation of arousal level and can be alleviated by adding environmental stimulation to increase levels of arousal. Method: To test this prediction, we studied the effects of adding background "pink noise" on impulsive choice using a classical and new adjusting choice delay task in a sample of 25 children with ADHD and 28 controls. Results: Children with ADHD made more impulsive choices than controls. Adding noise did not reduce impulsive choice in ADHD. Conclusion: The findings add to the existing evidence on impulsive choice in ADHD, but no evidence is found for the SRD model’s explanation of this behavioral style. Alternative explanations for impulsive choice in ADHD are discussed. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To assess the effectiveness and feasibility of behavioral sleep intervention for medicated children with ADHD. Method: Six medicated children (five boys, one girl; aged 6-12 years) with ADHD participated in a 4-week sleep intervention program. The main behavioral strategies used were Faded Bedtime With Response Cost (FBRC) and positive reinforcement. Within a case-series design, objective measure (Sleep Disturbance Scale for Children [SDSC]) and subjective measure (sleep diaries) were used to record changes in children’s sleep. Results: For all six children, significant decrease was found in the severity of children’s sleep problems (based on SDSC data). Bedtime resistance and mean sleep onset latency were reduced following the 4-week intervention program according to sleep diaries data. Gains were generally maintained at the follow-up. Parents perceived the intervention as being helpful. Conclusion: Based on the initial data, this intervention shows promise as an effective and feasible treatment. (J. of Att. Dis. 2013; XX(X) 1-XX)
Attention deficit and hyperactivity are known possible symptoms or correlates of obstructive sleep apnea (OSA). However, these associations may be missed in children, because children often fail to report excessive daytime sleepiness, and attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are common primary diagnoses in themselves. We report on a 17-year-old, slender, non-snoring male who presented to his pediatrician with a prolonged history of four complaints: inattention, fidgeting, frequent sinusitis, and somnolence. He was diagnosed with ADHD, while the somnolence, which often abated somewhat upon use of antibiotics for sinusitis, was attributed to the sinus infections. A later sleep study revealed OSA, and thorough additional testing proved that the original ADHD diagnosis was in error. All four conditions were allayed with proper use of a continuous positive airway pressure (CPAP) machine. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: To study the quality of life in adults aged 50+ with ADHD. Method: An anonymous questionnaire survey was performed on 148 adults aged 50+ with ADHD. Quality of life was assessed with EuroQol and the Satisfaction With Life Scale. Age-matched Norwegian and Danish population samples served as reference groups. Results: Mean age of participants was 55.7 years, and mean age when diagnosed with ADHD was 50.2 years, while mean Adult ADHD Self-Report Scale Screener score was 15.2. Adults with ADHD reported significantly reduced health-related quality of life and reduced satisfaction with life compared with population norms. Nonemployment and severe ADHD were associated with poor quality of life. Conclusion: Adults aged 50+ with ADHD diagnosed in late adulthood reported significantly reduced quality of life when compared with population norms. The negative impact of ADHD persists into late adulthood. (J. of Att. Dis. 2013; XX(X) 1-XX)
Objective: The purpose of this study is to assess the sleep behaviors, sleep problems and frequency, and relationship with psychiatric comorbidities in ADHD Combined type and to evaluate the effect of sleep problems on quality of life. Method: Forty-six boys, aged 7 to 13 years, with ADHD-combined type and 31 healthy boys were included. ADHD children were never treated for sleep or psychiatric disorders. Intelligence quotient (IQ) test scores were minimum 80, body mass index were normal and did not have medical disorders. Parents completed Children’s Sleep Habits Questionnaire, Conners’ Parent Rating Scale and The Pediatric Quality of Life Inventory (PedsQL) and participants were asked about sleep behaviors and were administered PedsQL and Schedule for Affective Disorders and Schizophrenia. Results: The frequency of sleep problems in ADHD is 84.8%, higher than the control group (p = .002). Evaluating PedsQL scores, the quality of life is worse in physical, psychosocial health, and total life quality (p < .05). ADHD group with sleep problems have more night wakings than control group with sleep problems (p = .02). The comorbidity do not increase sleep problems. The frequency of parasomnias is increased in group with learning disorders (p = .05). Conclusion: The results of this study, which controls for a number of possible confounders found in previous examinations of ADHD and sleep, support the results of a number of other studies that have found an increased overall prevalence of parent-reported sleep disturbances in children with ADHD compared with healthy control participants. As the ADHD group have more night wakings than the control group through the night, it is thought that night wakings that cause a partitioned sleep may be important signs seen in ADHD. That could be suggested by two hypotheses. First one is that, daytime sleepiness is more common in ADHD and those children present excessive hyperactivity during the day to stay awake and the second one is the improvement of ADHD signs when the drugs for sleepiness are used. Usage of standardized and valid diagnostic criteria, exclusion of adolescence, gender, socioeconomic level, primary sleep problems, medical disorders and low IQ level, making allowances for effect of comorbidities and having compared with the control group are the important methodological features of this study. The most important limitation of this study is small sample size that makes the findings less generalizable to other groups of children with ADHD, and another one is not having used objective measurements together with subjective measurements. In conclusion, these results underscore the importance of screening all children who have a symptom constellation suggestive of ADHD for sleep problems that may either play a causative role or exacerbate the clinical appearance of ADHD in a given child. Correct evaluation and treatment of sleep problems inc